Jasminka Nancheva, Alan Andonovski, Daniela Georgieva, Zoran Bozinovski, Roza Dzoleva, Antonio Gavrilovski, Antonio Georgiev


Abstract: Introduction: Peripherial nerve blocks is a suitable alternative to general anesthesia especially for one-day case surgery. Interscalene approach of plexus brachialis block as much as supraclavicular and infraclavicular provide reliable, safe, effective, low cost and most complete anesthesia with satisfactory postoperative analgesia for upper limb surgery. Postoperative analgesia of plexus brachialis blocks can be prolonged by using different drugs as adjuvants with local anesthetics. Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. The investigation was randomized, prospective, double blinded and controlled study.

Objective: The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in interscalene brachial plexus block on the onset, duration and postoperative analgesia in patients under the shoulder surgery.

Methods: A prospective, double-blind study was undertaken in patients scheduled for shoulder surgeries under the interscalene brachial plexus block. We enrolled 60 patients, ASA I-II both sexes, aged 19-65 years, weighing 54-89 kg, divided to two groups G1 and G2. The brachial plexus block was performed by interscalene approach and mixture of 2% lidocaine (12ml) and 0.5% bupivacaine (22 ml) either alone or combined with dexamethasone (4 mg). The block was performed by using double technique neurostimulator/ultrasound technique.

Results: In our investigation we found a significant increase in onset and duration of motor and sensory block in Group G2 (with dexamethasone) as compared to Group G1 patients (p < 0.01).

Conclusion: Addition of dexamethasone to local anesthetic drugs in interscalene plexus brachialis block, significantly prolongs the duration of analgesia and motor block in patients undergoing shoulder arthroscopy. Moreover, it is a remarkably safe and costeffective method of providing postoperative analgesia.

Key words: regional anesthesia, interscalene plexus block, adjuvants, dexamethasone.


regional anesthesia; interscalene plexus block; adjuvants; dexamethasone

Full Text:



Golwala MP, Swadia VN, Dhimar AA, Sridhar NV. Pain relief by dexamethasone as an adjunct to local anaesthetics in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2009; 25(3): 285–8

McCartney C, Duggan E Apatu E. Should we add clonidine to local anesthetic for peripherial nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med. 2007; 32(4): 330–8.

Choi R, Rodseth C, McCartney J. Effects of dexamethason as local anesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials. Br. J Anaesth. 2014; 112(3): 427–39

Vieira PA, Pulai I, Tsao GC, Manikantan P, Keller B, Connelly NR. Dexamethason with bupivacain increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiolog. 2010; 27(3): 285–8.

Desmet M, Braems H, Reynovet M et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study.Br. J Anaesth. 2013; 111(3): 445–52.

Axelsson K, Gupta A. Local anaesthetic adjuvans: neuroaxial versus peripherial nerve block. Curr Opinionin Anaesthesiol. 2009; 22(5): 649–54.

Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: a systematic review. Anesth Analg. 2000; 90(5): 1122–8.

Strichartz GR, Berde CB. Local anesthetics. In: Miller RD, editor. Miller’s anesthesia. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. pp. 573–603.

Biradar PA, Kaimar P, Gopalakrishna K. Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study. Indian Journal of Anaesthesia. 2013; 57(2): 180–4.

Kumar S, Palaria U, Sinha AK, Punera DC, Pandey V. Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia. Anesth Essays Res. 2014; 8(2): 202–8.

Shaikh MR, Majumdar S, Das A. Role of Dexamethasone In Supraclavicular Brachial Plexus Block.IOSR-JDMS. 2013; 12: 1–7.

Persec J, Persec Z, Kopljar M, et al. Low-dose dexamethasone with levobupivacaine improves analgesia after supraclavicular brachial plexus blockade. Int Orthop. 2014; 38(1):101–5.

Pathak RG, Satkar AP, Khade RN. Supraclavicular brachial plexus block with and without dexamethasone - A comparative study. Int J Sci Res Publi. 2012; 2: 1–7.

Parrington SJ, O’Donnell D, Chan VW, at al. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Reg Anesth Pain Med. 2010; 35(5): 422–6.

Shrestha BR, Maharjan SK, Shrestha S, et al. Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block. JNMA J Nepal Med Assoc. 2007; 46(168): 158–64.

Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade. AnesthAnalg. 2006;102(1):263–7.

Cummings KC, Napierkowski DE, Para-Sanchez I, et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacain or bupivacaine. Br J Anaesth 2011; 107: 446–53.

Shahedha P, Vardhan V, Lakhami B. Efect of intravenous dexamethasone in prolonging the duration of supraclavicular brachialis plexus block with 0.55 ropivacaine; a prospective randomized, placebo controlled study. Int J of Scientic Study. 2015; 2(10): 56–60.

Mahmoud M, Azza A, Heffni A. Dexamethasone bupivacaine versus bupivacaine for peribulbar block in posterior segment eye surgery. Egiptian J of Anaesthesia. 2013; 29(4): 407–11.

Stan T, Goodman EJ, Bravo-Fernandez C, Holbrook CR. Adding methylprednisolone to local anesthetic increases duration of axillary block. Reg Anesth Pain Med. 2004; 29(4): 380–1.



  • There are currently no refbacks.

Copyright (c) 2016 SANAMED

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.