Previous studies have confirmed that IV dexamethasone prolongs brachial plexus blocks. However, these studies only used fixed doses of IV dexamethasone at relatively high doses, which could potentially lead to increased glucose levels, delayed wound healing, and unintended side effects. There remains a paucity of research on the effective dose range of IV dexamethasone for the prolongation of supraclavicular blocks. The optimal dosage of IV dexamethasone for prolongation of analgesia vs. motor block prolongation from supraclavicular blocks in shoulder surgery has yet to be delineated.
Numerous studies have confirmed that perineural dexamethasone prolongs bupivacaine and ropivacaine brachial plexus blocks by approximately 10 hours (from approx. 12 to 22 hours) without clinical evidence of toxicity. However, perineural toxicity in an animal model has raised concern about its use as a peripheral nerve block adjuvant. Moreover, recent studies suggest that high dose IV dexamethasone (810mg) prolongs analgesia to a similar degree as perineural dexamethasone for interscalene, supraclavicular and sciatic nerve blocks performed with ropivacaine and bupivacaine. However these studies only utilized fixed, high level doses of IV dexamethasone. Moreover, there remains a concern that high dose IV dexamethasone may lead to postoperative hyperglycemia and could possibly increase the risk of postoperative wound infection. Open surgery under general anesthesia has been shown to increase blood glucose levels with a peak at approximately 2 hours post-induction and results have been conflicting regarding whether or not IV dexamethasone causes greater increase. To the investigators' knowledge, it is not yet known if arthroscopic surgery under regional anesthesia triggers a similar increase in blood glucose levels and if this is impacted by administration of IV dexamethasone. The investigators aim to identify the duration of supraclavicular block prolongation that can be expected over a range of doses of IV dexamethasone. The investigators also seek to identify what association, if any, is noted between IV dexamethasone and changes in blood glucose levels after shoulder surgery with regional anesthesia and sedation. Finally, the investigators will collect data on side effects and postoperative complications, if any, in patients receiving a range of doses of IV dexamethasone.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
QUADRUPLE
Enrollment
140
Hospital for Special Surgery
New York, New York, United States
Duration of Analgesia From a Supraclavicular Block Performed for Shoulder Arthroscopy
Defined as time from block placement until "pain relief from the block completely wears off" in the operative shoulder.
Time frame: Day of Surgery until Post-Operative Day 3 (if the block persists)
Duration of Motor Block From the Supraclavicular Block
Defined as the time from block placement to restoration of normal strength at both the wrist and elbow.
Time frame: Day of Surgery until Post-Operative Day 3 (if the block persists)
Blood Glucose Levels
Fingerstick blood glucose test to be administered before and 1-hour and 2-hours after IV dexamethasone administration.
Time frame: Day of Surgery - before and 1-hour and 2-hours after IV Dexamethasone administration
Occurrence of Postoperative Neuropraxia
Documentation of any of these occurrences will be obtained from the surgeons and/or medical charts after the postoperative follow up visit.
Time frame: Post-Operative Day 21
Occurrence of Postoperative Wound Infection
Documentation of any of these occurrences will be obtained from the surgeons and/or medical charts after the postoperative follow up visit.
Time frame: Post-Operative Day 21
Average Daily Pain Scores at Rest and With Movement
Using the Numeric Rating Scale (NRS) Pain obtained by patient interview. Lower numbers represent less pain and better outcomes. The scale range is from 0 (no pain) to 10 (worst pain possible).
Time frame: Day of Surgery until Post-Operative Day 3 (if the block persists)
Worst Daily Pain Scores at Rest and With Movement
Using the numeric pain rating scale (NRS), will be obtained by patient interview. Lower numbers represent less pain and better outcomes. The scale range is from 0 (no pain) to 10 (worst pain possible).
Time frame: Day of Surgery until Post-Operative Day 3 (if the block persists)
Patient Satisfaction With Postoperative Analgesia
Patient satisfaction with postoperative analgesia will be obtained by patient interview. Lower numbers represent worse outcomes. The scale range is from 0 (worst) to 10 (best).
Time frame: Post-Operative Day 2 or Post-Operative Day 3 (if the block persists)
Cumulative Daily Opioid Usage
Dosages (reported in Morphine equivalent units) of opioid medication obtained by medical records and/or by patient interview.
Time frame: Recovery Room until Post-Operative Day 3 (if block persists)
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