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REGIONAL ANESTHESIA

Dexamethasone Added to Lidocaine Prolongs Axillary Brachial Plexus Blockade

Ali Movafegh, MD^*, Mehran Razazian, MD^*, Fatemeh Hajimaohamadi, MD^*, and Alipasha Meysamie, MD

*Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital; and Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran

Address correspondence and reprint requests to Ali Movafegh MD, Department of Anesthesiology and Critical Care, No: 57, 25^th Ave, Jahan Ara Street, Tehran 1438794811, Iran. Address e-mail to movafegh{at}sina.tums.ac.ir or ali{at}movafegh.com.

Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 ± 76 versus 98 ± 33 min) and motor (310 ± 81 versus 130 ± 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999