RESUMEN
Background: Pectoral nerve (Pecs) block is an effective component of multimodal analgesic regimens for breast surgeries. In present study we compared analgesic effect of dexamethasone 8 mg as an adjuvant to 0.25% ropivacaine versus 0.25% ropivacaine alone in pectoral nerve block. Methods: The study was conducted in a randomized manner on 60 female patients of American Society of Anesthesiologists (ASA) Grade I and II, aged between 18 to 65 years, scheduled to undergo modified radical mastectomy under general anesthesia (GA). The patients were randomly allocated into 2 groups of 30 patients each. Group A received ultrasound (US)-guided Pecs block with 30 ml of 0.25% ropivacaine and 10 ml normal saline (total volume 40 ml) and Group B received with 30 ml of 0.25% ropivacaine and 8 mg dexamethasone in and 10 ml normal saline (total volume 40 ml). Post-operatively visual analogue score (VAS), duration of analgesia and total analgesic consumption was noted. Student t-test, Mann Whitney U test and Chi-square test were used for statistical analysis. Results: VAS were persistently low for first 4 hours in group B and for first 9 hours in group A (p value < 0.001 at some intervals). The mean duration of analgesia was prolonged in group B as compared to group A (612.33 ± 41.77 min in Group B and 307.70 ± 22.37min in group A) (p <0.001). Total analgesic consumption in first 24 hours post-operatively was also statistically lower in Group B (97.50± 34.96 mg) as compared to group A (177.50± 36.76) (p<0.001). No patient under study reported any adverse effects. Conclusion: Addition of 8 mg dexamethasone as adjuvant to 0.25% ropivacaine for pectoral nerve block increases the duration of analgesia and significantly reduces the amount of analgesic requirement in first 24 hours postoperatively without any significant adverse effects.
RESUMEN
Interscalene block is commonly used for anesthesia and analgesia in patients undergoing surgeries of shoulder and upper arm. Combination of lignocaine and bupivacaine is commonly used for this purpose. Addition of dexamethasone to local anesthetic drugs is reported to cause rapid onset and enhance the duration of anesthesia and analgesia. We conducted this study to compare the analgesic effect in interscalene block with local anesthetic versus local anesthetic and steroid. Methods: This was a prospective comparative study conducted in the department of anesthesiology of a tertiary care medical college situated in an urban area. In this study total 120 patients undergoing upper limb surgery under interscalene block were included on the basis of a predefined inclusion and exclusion criteria. Out of these 120 patients 60 patients received lignocaine, adrenaline, bupivacaine and dexamethasone (Group A) whereas remaining 60 patients were given lignocaine, adrenalin, bupivacaine and distilled water (Group B). The comparison of onset of analgesia, onset and duration of motor blockade as well as onset and duration of sensory blockade was compared in both the groups. For statistical analysis SSPE 21.0 software was used and P value less than 0.05 was taken as statistically significant. Results: Majority of the studied cases belonged to the age group of 21-30 years (24.17%) followed by 31-40 years (23.33%). The mean age of patients in both the group was found to be comparable with no statistically significant difference between mean age of both the groups (P>0.05). The mean time for onset of analgesia in Group A and Group B was found to be 7.43 +/- 1.65 and 6.01+/- 1.55. The difference was found to be statistically significant (P<0.0001). The duration of sensory and motor blockade was found to be 14.6+/-12.5 and 11.93+/- 1.48 in group A. where as in group B it was found to be 11.8+/-0.8614 and 8.85 +/- 1.15 respectively. Onset of sensory blockade was found to be 7.01 +/-2.12 and 9.09 +/- 3.08 in group A and group B respectively. The difference was found to be statistically significant for duration of sensory and motor blockade. Onset of motor blockade was found to be comparable in both the groups with no statistically significant difference (P>0.05). Conclusion: Addition of dexamethasone to local anesthetic agent for interscalene block is associated with rapid onset of analgesia and a prolonged duration of motor and sensory blockade.