Evaluation of Adjuvant Use in Selective Trunk Block

Gaziosmanpasa Research and Education Hospital71 enrolled

Overview

"Evaluation of the Anesthetic and Analgesic Efficacy of Dexamethasone in Selective Trunk Blocks

the investigators hypothesize that the perineural application of dexamethasone as an adjuvant in selective trunk block for upper extremity surgeries will accelerate the onset time of anesthesia and analgesia, provide significant anesthetic and analgesic effects, and prolong the duration of anesthesia and analgesia. In recent years, the brachial plexus block, performed with various approaches, has been preferred over general anesthesia for upper extremity orthopedic surgeries due to its numerous advantages. It maintains the patient's consciousness and spontaneous respiration, reduces airway interventions, provides effective postoperative pain control, minimizes opioid-related side effects, limits surgery-related metabolic and endocrine changes, enables early discharge, and reduces treatment costs. Selective trunk block offers rapid block onset and high success rates. The use of ultrasound in peripheral blocks has also reduced the risk of various complications (e.g., vascular injury). The selective trunk approach, as described by Manoj Kumar Karmakar in 2020, involves blocking the upper, middle, and lower trunks at the C7 transverse process level, resulting in sensory/motor block in all ipsilateral upper extremity dermatomes except T2. This study aims to compare the anesthetic and analgesic efficacy of dexamethasone as an adjuvant to bupivacaine in the selective trunk block approach. Dexamethasone is a widely used glucocorticoid with anti-inflammatory, anti-toxic, and other effects. It has strong lipophilic properties, is soluble in fat, increases pH, facilitates the penetration of local anesthetics into nerve sheaths, and extends the duration of local anesthetic effects, as supported by various studies. Additionally, dexamethasone is commonly used in pain management for its neuromodulatory effects.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

Conditions

Analgesia Nerve Blocks Postoperative Pain, Acute

Interventions

DexamethasonePROCEDURE

In the adjuvan group (dexamethasone)group, a total of 25 ml of local anesthetic mixture will be applied, consisting of 23 ml of 0.5% bupivacaine and 2 ml of dexamethasone(8mg).

kontrol groupPROCEDURE

In the control group, a total of 25 ml of local anesthetic mixture will be applied, consisting of 23 ml of 0.5% bupivacaine and 2 ml of 0.9% saline.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Patients undergoing upper extremity surgery with ASA (American Society of Anesthesiologists) classification I-II * aged 18-65 years, and with a body mass index (BMI) between 18-35 kg/m² were included in the study. Exclusion criteria: * included ASA III-IV patients * those who refuse the block * pregnant and breastfeeding women * individuals with severe lung disease * contralateral diaphragm paralysis * nerve injury secondary to trauma * neuromuscular diseases, * peripheral neuropathy * bleeding diathesis * history of anticoagulant use * allergies to local anesthetics or dexamethasone * uncontrolled diabetes mellitus * morbid obesity with BMI \>35 kg/m² * severe cardiovascular, renal, or liver disease, and infections at the site where the nerve block is to be applied.

Locations (1)

Gaziosmanpasa Research and Education Hospital

Istanbul, Turkey (Türkiye)

Outcomes

Primary Outcomes

onset times of motor and sensory blocks

primary aim is to compare the effects of adding dexamethasone as an adjuvant to bupivacaine in selective trunk blocks on the onset times of motor and sensory blocks required for anesthesia.

Time frame: first 30 minutes after the block aplication

Secondary Outcomes

postoperative total motor block duration and analgesia duration.

To compare the effects of dexamethasone as an adjuvant on postoperative total motor block duration and analgesia duration

Time frame: within 24 hours after the surgery

first postoperative rescue analgesia

To evaluate the time to the first postoperative rescue analgesia

Time frame: within 24 hours after the surgery hours

Data from ClinicalTrials.gov

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