A comparative study between regional and intravenous dexamethasone in the prophylaxis of rebound pain after supraclavicular block in upper limb surgeries: a double-blinded study

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Background Dexamethasone, a strong anti-inflammatory medication, might mitigate the inflammatory cascade initiated by surgical trauma. Aim To compare the impact of regional and intravenous (i.v.) dexamethasone in the prophylaxis of rebound pain following supraclavicular block in upper limb surgeries. Patients and methods This prospective randomized, double-blind study was carried out on 90 participants who underwent upper limb surgeries using general anesthesia. Patients had been assigned at random into two groups equally: all patient were generally anesthetized and received supraclavicular brachial plexus block (0.25% bupivacaine at a dose of 2 mg/kg in a total volume=20 ml and 18 ml 0.25% bupivacaine plus dexamethasone 8 mg, 2 ml dexamethasone) and 2 ml of normal saline (as placebo) were given i.v. in regional dexamethasone group (R) and 8 mg (in 2 ml volume) of dexamethasone i.v. in i.v. dexamethasone group (I). Results The time to initial request of rescue analgesics had been substantially delayed in group A compared to group B ( P <0.001). Total dose of pethidine consumption in the first 24 h was significantly lower in group A than in group B ( P <0.001). Conclusion Regional administration of dexamethasone in patients undergoing supraclavicular block for upper limb surgeries offers superior intraoperative and postoperative benefits compared to i.v. administration. Specifically, patients receiving regional dexamethasone exhibited more stable hemodynamic, lower intraoperative and postoperative opioid requirements, lower postoperative pain, and extended time first to rescue analgesia. Also, regional dexamethasone had superiority to i.v. dexamethasone in reducing rebound pain.