{"title":"Dexamethasone Added to Mixed Local Anesthetics in Infraclavicular Block: The Dexamethasone Paradox in Chronic Pain.","authors":"E M Simsek, H Kaşıkara","doi":"10.4103/njcp.njcp_36_25","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Dexamethasone is commonly used as an adjuvant to prolong analgesia in peripheral nerve blocks. However, there are a few studies available regarding its use in combination with mixed local anesthetics.</p><p><strong>Aim: </strong>This study investigated the effect of adding perineural dexamethasone to an infraclavicular block containing a medium- and long-acting local anesthetic mixture on the time to the first analgesia request (sensory block duration) as the primary outcome, as well as sensory and motor block onset times, motor block duration, postoperative analgesic use, and the development of long-term chronic pain as secondary outcomes.</p><p><strong>Materials and methods: </strong>This study included patients over 18 years of age and scheduled for upper extremity surgery. For patients in Group S, the block consisted of 10 mL of 0.5% bupivacaine, 5 mL of 2% prilocaine, and 5 mL of 0.9% saline solution. Patients in Group D received the same LA mixture with 2 mL of dexamethasone (8 mg) and 3 mL of 0.9% saline. Sensory and motor block level and Visual Analogue Scale (VAS) pain scores were recorded at postoperative 1, 12, and 24 hours. At least 6 months after surgery, the patients were contacted by phone and assessed for the presence of postoperative chronic pain, patient satisfaction, and whether they were receiving physical therapy.</p><p><strong>Results: </strong>Sensory block duration was significantly longer in the dexamethasone group. VAS scores at postoperative 12 hours and analgesic use were lower in the dexamethasone group. Long-term postoperative chronic pain was observed in one patient that received dexamethasone, but the difference between the groups was not significant.</p><p><strong>Conclusion: </strong>The addition of dexamethasone as an adjuvant to mixed local anesthetics in the infraclavicular block made a significant difference by reducing the need for postoperative analgesia.</p>","PeriodicalId":19431,"journal":{"name":"Nigerian Journal of Clinical Practice","volume":"28 8","pages":"955-961"},"PeriodicalIF":0.7000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nigerian Journal of Clinical Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/njcp.njcp_36_25","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/30 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Dexamethasone is commonly used as an adjuvant to prolong analgesia in peripheral nerve blocks. However, there are a few studies available regarding its use in combination with mixed local anesthetics.
Aim: This study investigated the effect of adding perineural dexamethasone to an infraclavicular block containing a medium- and long-acting local anesthetic mixture on the time to the first analgesia request (sensory block duration) as the primary outcome, as well as sensory and motor block onset times, motor block duration, postoperative analgesic use, and the development of long-term chronic pain as secondary outcomes.
Materials and methods: This study included patients over 18 years of age and scheduled for upper extremity surgery. For patients in Group S, the block consisted of 10 mL of 0.5% bupivacaine, 5 mL of 2% prilocaine, and 5 mL of 0.9% saline solution. Patients in Group D received the same LA mixture with 2 mL of dexamethasone (8 mg) and 3 mL of 0.9% saline. Sensory and motor block level and Visual Analogue Scale (VAS) pain scores were recorded at postoperative 1, 12, and 24 hours. At least 6 months after surgery, the patients were contacted by phone and assessed for the presence of postoperative chronic pain, patient satisfaction, and whether they were receiving physical therapy.
Results: Sensory block duration was significantly longer in the dexamethasone group. VAS scores at postoperative 12 hours and analgesic use were lower in the dexamethasone group. Long-term postoperative chronic pain was observed in one patient that received dexamethasone, but the difference between the groups was not significant.
Conclusion: The addition of dexamethasone as an adjuvant to mixed local anesthetics in the infraclavicular block made a significant difference by reducing the need for postoperative analgesia.
期刊介绍:
The Nigerian Journal of Clinical Practice is a Monthly peer-reviewed international journal published by the Medical and Dental Consultants’ Association of Nigeria. The journal’s full text is available online at www.njcponline.com. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. The journal makes a token charge for submission, processing and publication of manuscripts including color reproduction of photographs.