Abstract
Background: Through the use of bupivacaine-induced brachial plexus blocking, it is possible to achieve high levels of anaesthesia and analgesia for surgical procedures. Previous research studies have shown that steroids also reduce the ectopic firing of nerve impulses from the adjacent neurons when given in combination with an anaesthetic drug. The aim of current study was to determine the prolongation of local anaesthesia in brachial plexus through bupivacaine by the addition of dexamethasone.
Material and Methods: The study was conducted at Department of Anaesthesiology, Khyber Teaching Hospital, Peshawar. The study was approved by the Institutional Ethical Committee and written informed consent was taken from each participant. The sample size was calculated through World Health Organization (WHO) online sample size calculator taking 95% confidence interval with 14% margin of error. Hence, a total of 60 class-I and class-II patients were enrolled in the experiment as per classification of American society of Anesthesiology (ASA). Patients, ranging in age from 18 to 60 years old, who had undergone elective surgery on their upper extremities were included in this study. They were separated into two groups of almost equal size. Treatments for patients in Group-1 consisted of 1.5 mL of 0.5 percent bupivacaine and 8 mL of dexamethasone administered intravenously. Participants in Group-2 (the controls) received a 1.5 mL solution containing a 5 percent bupivacaine solution as well as a 9 percent normal saline solution. We compared the two groups to evaluate if there were any differences in the onset, duration, and intensity of postoperative analgesia induced by sensory and motor blocking between the two groups. The results were statistically analyzed through IBM SPSS v.22 software. P- value less than 0.05 was considered significant.
Results: The mean age of the patients in group-1 was 42.6±13.6 years whereas in group-2 mean age was 37.8±12.5 years. For group-1 the onset of motor block was 3.8 ± 0.8 minutes and for group-2, it was 17.5 ± 2.3 minutes. Onset of sensory block for group-1 was 7.2 ± 1.5 minutes and for group-2, it was 15.6 ± 1.6 minutes. Duration of surgery for group-1 was 49.5±18.8 minutes whereas for group-2 it was 47.6±15.9 minutes. The p-value for surgery duration was 0.445. Duration of motor block for group 1 was 667 minutes with 85 as SD value and for group 2 it was 289 minutes with 56 as SD value and <0.01 as p value. For group 1 and 2 the duration of sensory block in minutes was 798 ± 13.5 and 355 ± 12.9 as mean and SD respectively and <0.01 as p value. Duration of analgesia for group 1 was 824 minutes as mean and 13.8 as SD whereas for group 2 it was 390 minutes as mean and 44 as SD value. The value of p for this factor was <0.01. The p values show that the test analysis is significant statistically.
Conclusion: The addition of bupivacaine to dexamethasone significantly accelerates the onset of sensory and motor blockage in the patient. Similarly, dexamethasone adjuvant is completely safe and has no negative effects when used in the brachial plexus block.
