Ropivacaine Block Alone or With Perineural or Systemic Dexamethasone for Pain in Shoulder Surgery

Mayo Clinic130 enrolled

Overview

Pre-operative perineural injection of dexamethasone mixed with local anesthetic in peripheral nerve blockade for orthopedic surgery has been shown to prolong the length of analgesia, improve visual analog pain scores, decrease post-operative opioid use, and decrease post-operative nausea. No study has been published to determine if this effect is a result of systemic absorption of dexamethasone or is a local effect of the drug on neuronal activity at the injection site. This study is a prospective, randomized, double-blind, controlled study to compare pain block with (1) ropivacaine and saline plus intravenous saline vs (2) ropivacaine and dexamethasone plus intravenous saline vs (3) ropivacaine and saline plus intravenous dexamethasone. Patients will be recruited sequentially and assigned to the three groups at random in equal ratios. The hypothesis is that dexamethasone injected perineurally in combination with ropivacaine for interscalene brachial plexus block will yield longer duration of sensory blockade as compared to ropivacaine alone without intravenous or perineural dexamethasone and as compared to ropivacaine and intravenous dexamethasone. This result will suggest that the effect of dexamethasone is a result of direct neuronal activity at the injection site versus systemic absorption.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

QUADRUPLE

Enrollment

130

Conditions

Shoulder Injury

RopivacaineDRUG

25 ml ropivacaine 0.5%

DexamethasoneDRUG

8 mg dexamethasone (perineural)

DexamethasoneDRUG

8 mg dexamethasone (0.8 ml dexamethasone, 4.2 ml saline) to total volume of 5 ml (intravenous)

Normal salineDRUG

5 ml normal saline (intravenous)

Normal salineDRUG

0.8 ml normal saline (perineural)

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion criteria: 1. Patients undergoing elective shoulder surgery by one of two surgeons highly experienced in the procedure. 2. Patients are either: Opioid naïve; or Have not taken opiates for one month prior to surgery (tramadol is permissible). 3. Patients have an American Society of Anesthesiology physical status I-III. Exclusion criteria: 1. Females who are pregnant. 2. Patients who are taking chronic daily opiates for one month prior to surgery except tramadol. 3. Diabetic patients. 4. Patients with creatinine above 1.1mg/dL for females and above 1.3mg/dL for males. 5. Patients with contralateral pneumothorax or diaphragmatic paralysis. 6. Patients with coagulopathy. 7. Patients with clinically significant previous nerve injury in surgical extremity. 8. Patients with an allergy to NSAIDs. 9. Patients who are refusing a block. 10. Patients with a contraindication to ropivacaine, dexamethasone, or interscalene block due to other medical condition such as severe chronic obstructive pulmonary disease (COPD).

Outcomes

Primary Outcomes

Duration of Sensory Blockade

Duration from time of block until complete resolution of sensory blockade in the shoulder is recorded in minutes by patient report.

Time frame: Within 48 hours

Secondary Outcomes

Post Operative Opioid Dose at 24 Hours

Time frame: approximately 24 hours after surgery

Time Until First Dose of Analgesic

Time frame: Approximately 10 hours after surgery

Patient Satisfaction With Pain Control

Pain was rated on a visual analogue scale with 0 = no pain, 3=mild pain, 5=moderate pain, 7=moderate to severe pain, and 10=severe pain.

Time frame: 24 hours, 48 hours, 1 week