Abstract
PERINEURAL DEXAMETHASONE AND REBOUND PAIN FOLLOWING BUPIVACAINE SUPRACLAVICULAR BRACHIAL PLEXUS BLOCKADE

Sadeq M. Da’meh MD*, Rami A. Abudayyeh MD, Anan H. Qabaha MD, Mohammad J. Beidas MD, Thani O. Al Awamreh MD, Mohammad A. Adaileh MD, Nidal M. Al Soud MD, Moath M. Kreshan MD, Trad M. Al Halahlah MD

ABSTRACT

Background: Rebound pain following supraclavicular brachial plexus blockade is considered a serious limitation. Inadequate management is the most important cause of the rebound within peripheral nerve blockade diminishing. Objective: We determined whether perineural dexamethasone can reduce the frequency of rebound pain following bupivacaine supraclavicular brachial plexus blockade. Methods: This prospective, double-blinded and randomised investigation included 116 patients, of both sexes, aged 23–65 yrs., classed I-III by the American Society of Anaesthesiologists and assigned for upper limb surgical orthopaedic procedures using supraclavicular brachial plexus blockade at Royal Rehabilitation Centre, Amman, Jordan, during the period Jan 2020-Jan 2021. Group I patients (GI, n = 59) were administered 0.5% bupivacaine mixed with 6 mg dexamethasone, and Group II patients (GII, n = 57) were administered bupivacaine 0.5%. Rebound pain frequency 3 days following supraclavicular brachial plexus blockade was rated using a numeric rating scale pain score during 6, 16, 28 and 48 hrs. following the supraclavicular brachial plexus blockade, pain and paraesthesia within 2 weeks post-operation were. The Mann-Whitney U test was used for the continuous variables and the chi-square test to evaluate the correlation between the categorical variables. Results: The frequency of rebound pain was remarkably lower in Group I (6/59 [10.2%]) compared to Group II (27/57 [47.3%]); P < 0.005. Group allotment was correlated with rebound pain [OR = 0.041]. Patients in Group I had significantly lower numeric rating scale pain scores [4] compared to Group II [7] (P < 0.005). Regarding NRS pain scores after surgery, there was a remarkable discrepancy between groups only at 16 h after blockade, at rest (P < 0.05) and on movement (P < 0.005). Conclusions: Perineural 6 mg dexamethasone decreases rebound

Keywords: Supraclavicular brachial plexus blockade: bupivacaine, dexamethasone; Pain: rebound, numeric rating scale scores.


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