ABSTRACT
PURPOSE: The use of perineural dexamethasone as an adjuvant drug to peripheral nerve block for postoperative pain is controversial. This systematic review aimed to determine the effectiveness of adding dexamethasone to lidocaine in upper limb nerve blocks. DESIGN: Systematic review. METHODS: This review used a comprehensive search strategy to retrieve relevant published randomized trial articles that fulfilled the inclusion and exclusion criteria, without time limits, (until December 2023) that assessed the effects of a combination of dexamethasone to lidocaine in upper limb nerve blocks. The databases used for the electronic literature search included PubMed, Embase, and Clinical Trials.gov, dbGaP, Cochrane library, and Google Scholar. There was no language, gender, or age limitation. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. FINDINGS: Of 3,926 articles identified by the initial search, 8 studies that met our inclusion criteria. All articles were original research studies. All eight articles were clinical trials. The sample size in the selected studies ranged from 30 to 90 people. Studies demonstrated that combining dexamethasone with lidocaine significantly improved the quality of peripheral nerve blocks, increased the analgesia period, and decreased analgesic consumption. CONCLUSIONS: This review supported that the combination of dexamethasone (dose of 4 to 10 mg) and lidocaine (concentration of 1.5% to 2%) for upper limb block was more effective and beneficial without any side effects. However, further clinical trials in this regard with more data, various regions, and larger sample sizes to support our hypothesis are recommended.
ABSTRACT
Appropriate positioning of the head is a crucial step for a successful intubation. Laryngoscopy is a commonly used method to facilitate the intubation process. This study evaluated the quality of intubation and its difficulty in sniff and neutral position. This was a clinical randomized trial, conducted in 2021 in Aja university of medical sciences. 40 patients, meeting the inclusion criteria were randomly assigned to sniff and neutral group and were intubated with standard procedure. The required time, number of attempts, laryngeal view, cord status, and the need for maneuver were evaluated between the two positions. Overall, 60 patients were intubated in sniff and 60 in neutral position. 51 of them were male and 69 were female. The mean intubation time was (17/15 ± 8/00) and (16/65 ± 8/66) seconds in neutral and sniff position, respectively (p-value = 0.181). There was no statistically significant difference in the required time. Additionally, 45 patients were intubated in first attempt and 15 were intubated after the second attempt in each group. There was no difference in any difficulty-related parameter of the two groups. No significant difference between the required time, attempt, or any other parameter was detected between the sniff and neutral groups. Evidence suggests that there is no superiority regarding these two positions and the decision should be made by the physician on a case-by-case basis.
