Anesthésie et recherche clinique
Libre accès

Abstrait

Efficacy and Safety of Dexamethasone as an Adjuvant to Local Anesthetics in Lumbar Plexus Block in Patients Undergoing Arthroscopic Knee Surgeries

Bassant M Abdelhamid, Inas Elshzly, Sahar Badawy and Ayman Yossef

Background: The benefit of adding dexamethasone in regional anesthesia has recently been the focus of investigation as clinical reports suggest improved block characteristics. The aim of this study is to evaluate whether perineural administration of dexamethasone is more effective in prolonging the duration of lumbar plexus block than giving it systemically. Methods: 60 (out of 72) patients were recruited to undergo arthroscopic knee surgery using lumbar plexus block. These patients were divided randomly into 3 groups, 20 patients in each; group L (combined lumbar plexus and sciatic nerve block with bupivacaine 0.5%), group D (combined lumbar plexus and sciatic nerve block with bupivacaine 0.5%+8mg dexamethasone in LPB ) and group S (combined lumbar plexus and sciatic nerve block with bupivacaine0.5% +8mg intravenous dexamethasone). Results: patients showed statistically significant enhanced onset of sensory loss in group D when compared to group L (p value=0.04) but no statistically significant difference found between groups S and L (p value=0.13) or between groups D and S (p value=0.86). Regarding onset of motor loss it was found that group D enhanced onset of motor block significantly (p value<0.01) when compared to group L, while group S showed statistically insignificant enhancement of onset of motor block when compared to group L (p value=0.15) or group D (p value=0.71). Regarding sensory block duration (Postoperative analgesia), both groups D and S showed significant prolonged duration of analgesia (p value<0.01and0.04 respectively) when compared to group L, but no statistically significance detected when compared to each other (p value=0.24) which means they both similarly prolong duration of analgesia clinically. Motor block duration was significantly prolonged in group D when compared to groups L and group S (p value≤0.01).While group S didn’t show statistically significant prolongation of motor block when compared to group L (p value=0.4). Conclusion: Both perineural and IV administration of dexamethasone improve the efficacy of lumbar plexus block by prolonging the duration of analgesia, enhancing onset action of local anesthetics, and reducing postoperative analgesic requirements without increasing the incidence of complications.