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2016, vol. 11, br. 1, str. 15-20
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Da li dodatak deksametazona lokalnom anestetiku produžava trajanje analgezije kod interskalenskog bloka pleksusa brahijalisa kod pacijenata sa operacijom ramena?
Does the addition of dexamethason to local anesthetic prolong the analgesia of interscalen plexus brachialis block in patients with shoulder surgery?
aClinic for Orthopaedic Surgery, Medical Faculty, University 'St. Kiril and Metodij' Skopje, Rep. of Macedonia bUniversity Clinic for Orthopaedic Surgery, Medical Faculty Skopje, Republic of Macedonia
e-adresa: jasminkananceva@yahoo.com
Sažetak
Blokovi perifernih nerava su odgovarajuća zamena za generalnu anesteziju, posebno u jednodnevnim, kratkim hirurškim intervencijama. Interskaleni blok pleksusa brahijalisa, podjednako kao i supraklavikularni i infraklavikularni obezbeđuje pouzdanu, sigurnu, efektivnu, ekonomičnu i najkompletniju anesteziju sa zadovoljavajućom postoperativnom analgezijom za operacije gornjeg ekstremiteta. Postoperativna analgezija bloka pleksusa brahijalisa može biti produžena uz korišćenje drugih lekova kao dodataka lokalnim anesteticima. Deksametazon, primenjen kao dodatni lek, za blokiranje perifernih nerava, pokazao se kao odličan lek, koji produžava vreme postoperativne analgezije. Studija je randomizovana, prospektivna i dvostruko slepa i kontrolisana studija. Cilj: Studija je dizajnirana da uporedi efekte deksametazona, koji je primenjen kao dodatak bupivakainu u interskalenskom bloku pleksusa brahijalisa na po- četku, tokom trajanja i postoperativne analgezije kod pacijenata, podvrgnutih operaciji ramena. Metoda: Prospektivnoj, dvostruko slepoj studiji su podvrgnuti pacijenti, kojima je zakazana operacija ramena pod interskalenim blokom pleksusa brahijalisa. Uključili smo 60 pacijenta, ASAI-II oba pola, uzrasta 19-65 godina, težine 54-89 kg, podeljenih u dve grupe G1 i G2. Blok brahijalnog pleksusa je izveden interskalenim pristupom i miksturom 2% lidokaina (12 ml) i 0,5% bupivakaina (22 ml) bilo samih ili u kombinaciji sa deksametazonom (4 mg). Blok je postignut korišćenjem duple tehnike, neurostimulator/ultrazvuk tehnike. Rezultati: U našem istraživanju smo našli značajan porast na početku i tokom trajanja, motornog i senzornog bloka u Grupi 2 (sa deksametazonom) u poređenju sa Grupom 1 (p < 0,01). Zaključak: Dodavanje deksametazona lokalnim anesteticima u interskalenom bloku pleksusa brahialisa, značajno produžava vreme trajanja analgezije i bloka motornih funkcija kod pacijenata podvrgnutih artroskopiji ramena. šta više, pokazao se kao izuzetno siguran i ekonomičan metod u obezbeđivanju postoperativne analgezije.
Abstract
Introduction: Peripherial nerve blocks is a suitable alternative to general anesthesia especially for one-day case surgery. Interscalene approach of plexus brachialis block as much as supraclavicular and infraclavicular provide reliable, safe, effective, low cost and most complete anesthesia with satisfactory postoperative analgesia for upper limb surgery. Postoperative analgesia of plexus brachialis blocks can be prolonged by using different drugs as adjuvants with local anesthetics. Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. The investigation was randomized, prospective, double blinded and controlled study. Objective: The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in interscalene brachial plexus block on the onset, duration and postoperative analgesia in patients under the shoulder surgery. Methods: A prospective, double-blind study was undertaken in patients scheduled for shoulder surgeries under the interscalene brachial plexus block. We enrolled 60 patients, ASAI-II both sexes, aged 19-65 years, weighing 54-89 kg, divided to two groups G1 and G2. The brachial plexus block was performed by interscalene approach andmixture of2% lidocaine (12ml) and 0.5% bupivacaine (22 ml) either alone or combined with dexamethasone (4 mg). The block was performed by using double technique neurostimulator/ultrasound technique. Results: In our investigation we found a significant increase in onset and duration of motor and sensory block in Group G2 (with dexamethasone) as compared to Group G1 patients (p < 0.01). Conclusion: Addition of dexamethasone to local anesthetic drugs in interscalene plexus brachialis block, significantly prolongs the duration of analgesia and motor block in patients undergoing shoulder arthroscopy. Moreover, it is a remarkably safe and cost effective method of providing postoperative analgesia.
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Reference
|
|
  
|
Axelsson, K., Gupta, A. (2009) Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Current Opinion in Anaesthesiology, 22(5): 649-654
|
|
|
Berde, C.B., Strichartz, G.R. (2005) Local Anesthetics. u: Miller R.D. [ur.] Miller's Anesthesia, Philadelphia: Churchill-Livingstone, 913-939
|
|
|
Biradar, P., Kaimar, P., Gopalakrishna, K. (2013) Effect of dexamethasone added to lidocaine in supraclavicular brachial plexus block: A prospective, randomised, double-blind study. Indian Journal of Anaesthesia, 57(2): 180
|
|
2
|
Choi, S., Rodseth, R., McCartney, C.J.L. (2014) Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials. British Journal of Anaesthesia, 112(3): 427-439
|
|
1 
|
Cummings, K.C., Napierkowski, D.E., Parra-Sanchez, I., Kurz, A., Dalton, J.E., Brems, J.J., Sessler, D.I. (2011) Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. British journal of anaesthesia, 107(3): 446-53
|
|
|
Desmet, M., Braems, H., Reynvoet, M., Plasschaert, S., van Cauwelaert, J., Pottel, H., Carlier, S., Missant, C., van de Velde, M. (2013) I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. British Journal of Anaesthesia, 111(3): 445-452
|
|
|
Golwala, M.P., Swadia, V.N., Dhimar, A.A., Sridhar, N.V. (2009) Pain relief by dexamethasone as an adjunct to local anaesthetics in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol, 25(3); 285-8
|
|
|
Mahmoud, M.S., Alim, A.A.A.A., Hefni, A.F. (2013) Dexamethasone bupivacaine versus bupivacaine for peribulbar block in posterior segment eye surgery. Egyptian Journal of Anaesthesia, 29(4): 407-411
|
|
|
McCartney, C.J.L., Duggan, E., Apatu, E. (2007) Should We Add Clonidine to Local Anesthetic for Peripheral Nerve Blockade? A Qualitative Systematic Review of the Literature. Regional Anesthesia and Pain Medicine, 32(4): 330-338
|
|
|
Movafegh, A., Razazian, M., Hajimaohamadi, F., Meysamie, A. (2006) Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade. Anesthesia & Analgesia, 102(1): 263-267
|
|
|
Murphy, D.B., McCartney, C.J.L., Chan, V.W.S. (2000) Novel Analgesic Adjuncts for Brachial Plexus Block: A Systematic Review. Anesthesia & Analgesia, 90(5): 1122-1128
|
|
|
Palaria, U., Sinha, AjayK., Punera, D.C., Pandey, V., Kumar, S. (2014) Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia. Anesthesia: Essays and Researches, 8(2): 202
|
|
|
Parrington, S.J., o`Donnell Dermot,, Chan, V.W.S., Brown-Shreves, D., Subramanyam, R., Qu, M., Brull, R. (2010) Dexamethasone Added to Mepivacaine Prolongs the Duration of Analgesia After Supraclavicular Brachial Plexus Blockade. Regional Anesthesia and Pain Medicine, 35(5): 422-426
|
|
|
Pathak, R.G., Satkar, A.P., Khade, R.N. (2012) Supraclavicular brachial plexus block with and without dexamethasone - Acomparative study. Int J Sci Res Publi, 2: 1-7
|
|
1
|
Persec, J., Persec, Z., Kopljar, M., Zupcic, M., Sakic, L., Zrinjscak-Korecic, I., Marinic, D.K. (2013) Low-dose dexamethasone with levobupivacaine improves analgesia after supraclavicular brachial plexus blockade. International Orthopaedics, 38(1): 101-105
|
|
|
Shahedha, P., Vardhan, V., Lakhami, B. (2015) Effect of intravenous dexamethasone in prolonging the duration of supraclavicular brachialis plexus block with 0.55 ropivacaine: A prospective randomized, placebo controlled study. Int J of Scientic Study, 2(10): 56-60
|
|
|
Shaikh, M.R. (2013) Role of Dexamethasone In Supraclavicular Brachial Plexus Block. IOSR Journal of Dental and Medical Sciences, 12(1): 01-07
|
|
|
Shrestha, B.R., Maharjan, S.K., Shrestha, S., i dr. (2007) Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block. JNMA J Nepal Med Assoc, 46(168): 158-64
|
|
|
Stan, T., Goodman, E.J., Bravo-Fernandez, C., Holbrook, C.R. (2004) Adding Methylprednisolone to Local Anesthetic Increases the Duration of Axillary Block. Regional Anesthesia and Pain Medicine, 29(4): 380-381
|
|
|
Vieira, P.A., Pulai, I., Tsao, G.C., Manikantan, P., Keller, B., Connelly, N.R. (2010) Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. European Journal of Anaesthesiology, 27(3): 285-288
|
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