Comparing Variable Doses Of Dexamethasone As An Adjuvant To Levobupivacaine In Ultrasound Guided Supraclavicular Brachial Plexus Block For Patients Undergoing Orthopaedic Upper Limb Surgeries – A Prospective Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 58
- 试验地点
- 1
- 主要终点
- To assess the duration of analgesia between 4 mg of dexamethasone and 6 mg of dexamethasone
研究概览
简要总结
Supraclavicular Brachial Plexus block is a good alternative to general anaesthesia for upper
limb orthopaedic surgeries. This avoids the untoward effects of general anaesthetic drugs and
upper airway instrumentation in patients.
It achieves muscle relaxation, intraoperative hemodynamic stability and post-operative analgesia and reduces the requirement of post-operative opioid usage.
Considering the pharmacological profile of Bupivacaine, its clinical efficacy, long duration of action and favourable ratio of sensory to motor block it is used most frequently among local anaesthetics for brachial plexus block. However its major disadvantage is cardiotoxicity, primarily triggered by its dextrogyrous enantiomer
Levobupivacaine, a pure S- enantiomer of Bupivacaine has potentially reduced toxic profile compared to Bupivacaine. Levobupivacaine is a better drug for regional block due to its low cardiotoxic profile compared to Bupivacaine. Levobupivacaine’s efficacy proved similar or greater than Bupivacaine in regional blocks and could be used more safely in ASA grade 3 and 4 patients and cardiac patients in whom general anaesthesia is risky.
Peripheral nerve blocks with local anaesthetics provide excellent operating conditions,
facilitate early mobilisation and bypass the post anaesthesia care unit, but duration of
analgesia is rarely maintained for more than 4-8 hours even with the longest acting local
anaesthetics.
Perineural catheters can improve duration of analgesia from local anaesthetics but carry
problems of catheter migration, pump malfunction, leakage, etc.
Therefore, many adjuvants are added to the local anaesthetic in single shot regional
technique with variable results. Different drugs have been used as adjuvants with local
anaesthetics in brachial plexus block to achieve a quick, dense and prolonged block.
Various studies have shown that addition of corticosteroid dexamethasone, as a non
particulate injection, to local anaesthetics prolongs duration of blockade by approximately
8-10 hours in peripheral nerves.
However, the administration of dexamethasone is not risk free and concerns have been raised
regarding hyperglycaemia and surgical site infection. These adverse effects are likely to be
dose dependent. Owing to the potential toxicity concern, it may be beneficial to use lower
doses of dexamethasone, if these provide similar increase in analgesia duration compared to
higher doses
The purpose of this study is to compare the effectiveness, duration and quality of motor
blockade and sensory blockade between patients receiving of two relatively low doses (4 mg
and 6 mg) of dexamethasone, used as adjuvant to 0.25% levobupivacaine, for supraclavicular
brachial plexus block in patients undergoing upper limb orthopaedic surgeries
研究设计
- 研究类型
- Interventional
- 分配方式
- Computer generated randomization
- 盲法
- Participant and Outcome Assessor Blinded
入排标准
- 年龄范围
- 18.00 Year(s) 至 80.00 Year(s)（—）
- 性别
- All
入选标准
- •Elective and Emergency Orthopaedic Upper limb surgeries ASA I , II and III.
排除标准
- 未提供
结局指标
主要结局
To assess the duration of analgesia between 4 mg of dexamethasone and 6 mg of dexamethasone
时间窗: 0 hours , 2 hours , 4 hours , 8 hours , 12 hours , 24 hours
added to levobupivacaine
时间窗: 0 hours , 2 hours , 4 hours , 8 hours , 12 hours , 24 hours
次要结局
- To assess the Intensity of pain , Haemodynamic status of patients over 24 hours(0 hours to 24 hours)
- To assess the time taken for onset of sensory & motor block(0 mins , 2 mins , 4 mins , 6 mins , 8 mins , 10 mins , 12 mins , 14 mins , 15 mins)
- To assess the total requirement of rescue analgesia over a period of 24 hours post-(operatively)