Key result
Dexamethasone added to bupivacaine significantly shortened sensory block onset (10.02 vs 11.07 min) and prolonged analgesia (19.11 vs 13.07 hours) compared to midazolam for upper limb surgery.
Why the study?
The study was conducted to compare the additive effect of dexamethasone versus midazolam as an adjuvant to bupivacaine for the onset of sensory block and duration of analgesia in ultrasound-guided supraclavicular block.
Does dexamethasone compared to midazolam improve the onset of sensory block and duration of analgesia when added to bupivacaine in patients undergoing upper limb surgery under supraclavicular brachial plexus block?
RCT (n=264)
Randomly allocated (1:1)
Yes
Does dexamethasone compared to midazolam improve the onset of sensory block and duration of analgesia when added to bupivacaine in patients undergoing upper limb surgery under supraclavicular brachial plexus block?
Absolute Event Rate: 10.02% vs 11.07%
p-value: p=<0.001
Dexamethasone is superior to midazolam as an adjuvant to bupivacaine in supraclavicular brachial plexus block, providing faster onset of sensory block and prolonged analgesia.
Supports preferring dexamethasone over midazolam as bupivacaine adjuvant in supraclavicular block; extends RCT evidence on perineural adjuvants.
Objectives: The objective of this study was to compare the additive effect of dexamethasone versus midazolam as an adjuvant to bupivacaine for the mean duration of onset of sensory block and duration of analgesia with ultrasound guided supraclavicular block. Study Design: Randomized control trail. Setting: Research was jointly conducted at Arif Memorial Hospital affiliated with Rashid Latif Medical College and KEMU/Mayo Hospital Lahore under the auspices of Department of Anesthesiology. Period: 01/02/2017 to 30/06/2017. Material & Methods: Involved 264 patients of either sex, aged between 20-60 years undergoing upper limb surgery under ultrasound guided supraclavicular brachial plexus block. After obtaining informed consent, patients were randomly allocated into two treatment groups. Along with 0.5% bupivacaine, patients in Group-I received dexamethasone while those in Group-II received midazolam. Outcome variables were mean time to onset of sensory block and mean duration of analgesia which were noted and compared among the groups. Results: The mean age of the patients was 38.90±11.92 years. There were 201 (76.1%) male and 63 (23.9%) female patients in the study group. Majority (79.2%) of the patients belonged to ASA Class-I followed by ASA Class-II (20.8%). Mean time to onset of sensory block was significantly shorter with dexamethasone (10.02±1.26 vs. 11.07±1.38 minutes; p<0.001) as compared to midazolam and this difference was significant across all age, gender and ASA groups. Mean duration of analgesia was also significantly longer with dexamethasone (19.11±1.32 vs. 13.07±1.43 hours; p<0.001) as compared to midazolam and this difference was also significant across all age, gender and ASA groups. Conclusion: Addition of dexamethasone to bupivacaine in ultrasound guided supraclavicular brachial plexus block resulted in early onset of sensory block (10.02±1.26 vs. 11.07±1.38 minutes; p<0.001) and longer duration of analgesia (19.11±1.32 vs. 13.07±1.43 hours; p<0.001) as compared to midazolam in patients undergoing upper limb surgery irrespective of patient’s age, gender and ASA status.
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Iqbal et al. (2020) conducted an RCT in Upper limb surgery (n=264). Dexamethasone vs. Midazolam was evaluated on Mean time to onset of sensory block (minutes) (p=<0.001). Dexamethasone added to bupivacaine significantly shortened sensory block onset (10.02 vs 11.07 min) and prolonged analgesia (19.11 vs 13.07 hours) compared to midazolam for upper limb surgery.
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