Interscalene brachial plexus block can be used as an additive to general anaesthesia or as the primary anaesthetic for shoulder surgeries for pain management. The investigators compared the effect of perineural versus intravenous dexamethasone on the prolongation of the action of levobupivacaine in ultrasound guided interscalene block for shoulder and upper arm surgeries.
Dexamethasone had been shown to prolong the duration of postoperative analgesia when given as an adjuvant for peripheral nerve blocks. The investigators compared the effect of perineural versus intravenous dexamethasone on the prolongation of the action of levobupivacaine in ultrasound guided interscalene block for shoulder and upper arm surgeries. The study hypothesized that adding perineural dexamethasone to levobupivacaine in ultrasound guided interscalene block may be more superior to adding intravenous dexamethasone to levobupivacaine and levobupivacaine alone in shoulder and upper arm surgeries as regard analgesic effect, duration of analgesia and hemodynamic stability.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
DOUBLE
Enrollment
90
Patients will receive 20 ml of 0.25% levobupivacaine plus 2ml saline in interscalene brachial plexus block plus 10 ml intravenous saline.
Patients will receive 20 ml of 0.25% levobupivacaine plus 4mg dexamethasone diluted in 2 ml saline in interscalene brachial plexus block plus 10 ml intravenous saline.
Patients will receive 20 ml of 0.25% levobupivacaine plus 2ml saline in interscalene brachial plexus block plus 4 mg intravenous dexamethasone diluted in 10 ml saline.
Mansoura University
Al Mansurah, Dakhlia, Egypt
Duration of postoperative analgesia
as measured by time to first analgesic requirement.
Time frame: for 24 hour postoperatively
Onset of Sensory block
Patients will be closely observed until 30 minutes after the end of local anesthetic injection. Block success will be defined as loss of sensation to pinprick in the C4 and C5 sensory dermatome distribution measured 30 minutes after the end of local anesthetic injection. sensory block will be assessed by pin prick test using a 3point scale: • Grade 0 = Normal sensation. * Grade 1 = loss of sensation to pin prick (analgesia). * Grade 2 = loss of sensation to touch (anaesthesia). Onset time for sensory block will be defined as the time interval between the end of local anaesthesia administration and complete sensory block (score 2).
Time frame: For 30 min after injecting local anesthetic
Duration of sensory block
defined as the time interval between complete sensory block (score 2) and complete resolution of anaesthesia on all nerves (score 0)
Time frame: within 24 hours after the surgery.
Onset time of motor block
Motor block will be determined according to the modified Bromage scale: * Grade 0 = Normal motor function with full flexion and extention of elbow. * Grade 1 = Decrease motor power. * Grade 2 = Complete motor block. Onset time of motor block will be defined as the time interval between end of local anaesthetic administration and complete motor block (grade 2).
Time frame: For 30 min after injecting local anesthic
Duration of motor block
defined as the time interval between complete motor block (score 2) and complete recovery of motor function of the arm (score 0).
Time frame: within 24 hours after the surge
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Intraoperative Heart rate changes
Heart rate changes
Time frame: For 3 hours after surgery
Intraoperative Mean arterial blood pressure changes
Mean arterial blood pressure changes
Time frame: For 3 hours after surgery
Intraoperative analgesic consumption
the intraoperative analgesic dose consumption would be calculated The investigators can use fentanyl as analgesic if the patient required during the surgery ( 50-100 mic)
Time frame: For 3 hours after surgery
Postoperative heart rate changes
Time frame: For one hour after admission to the postoperative anesthesia care unit
Postoperative Mean arterial blood pressure changes
Time frame: For one hour after admission to the postoperative anesthesia care unit
Postoperative peripheral oxygen saturation changes
Time frame: For one hour after admission to the postoperative anesthesia care unit
Pain score
The VAS is represented with straight line with one end has the anchor " no pain" and it takes 0, while the other end of the line has the anchor " pain as bad as it could be" and it takes 10. The patient will receive the rescue analgesic when the score is more than 4)
Time frame: Pain after surgery will be assessed using VAS at 1,2,6,12 and 24 hours.
Total analgesic need and the onset of first intravenous analgesia
Total analgesic need to rescue analgesic (pethidine) calculated by mg. And the onset of time for first intravenous analgesia during the 24 hours postoperative by hours.
Time frame: After transportation of the patient from PACU up to 24 hours postoperative.
Patient satisfaction: 2-point scale
concerning the procedure is assessed using a 2-point scale (1= satisfied, I would want the same anesthesia / analgesia method for the next surgery, 2= unsatisfied, I would want a different anesthesia / analgesia method for the next surgery).
Time frame: first 24 hours postoperatively