• Reg Anesth Pain Med · Nov 2021

    Randomized Controlled Trial

    Perineural dexamethasone reduces rebound pain after ropivacaine single injection interscalene block for arthroscopic shoulder surgery: a randomized controlled trial.

    • Jae Hee Woo, Hyun Jung Lee, Hye-Won Oh, LeeJong WhaJWDepartment of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea., Hee Jung Baik, and Youn Jin Kim.
    • Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
    • Reg Anesth Pain Med. 2021 Nov 1; 46 (11): 965-970.

    Background And ObjectivesA single injection interscalene block (ISB) is a common regional analgesic technique in patients undergoing arthroscopic shoulder surgery. However, rebound pain after ISB resolution may reduce its overall benefit. Our primary aim was to assess whether perineural dexamethasone reduces the intensity and incidence of rebound pain in patients undergoing arthroscopic shoulder surgery under general anesthesia combined with a preoperative single injection ISB.MethodsThe patients were randomly assigned to receive single injection ISB using either 0.5% ropivacaine (control) or 0.5% ropivacaine containing 5 mg of dexamethasone. The primary outcomes were the pain score difference before and after ISB resolution, and the incidence of rebound pain. The secondary outcomes were the onset and duration of rebound pain, the presence of sleep disturbances due to postoperative pain, the first time when an analgesic was requested, and pain scores at various predefined time points.ResultsPain increase following ISB resolution was lower in the dexamethasone group compared with the control group (4.5±2.4 and 6.9±2.2, respectively, p<0.001). The incidence of rebound pain was significantly lower in the dexamethasone group compared with the control group (37.1% and 82.9%, respectively, p<0.001). The controls experienced greater sleep disturbance during the postoperative period compared with those who received ISB with perineural dexamethasone.ConclusionsPerineural dexamethasone added to ISB using ropivacaine led to a much smoother resolution of ISB, reflected in a significantly smaller increase in pain after block resolution, a lower incidence of rebound pain and a lower sleep disturbance during the first postoperative week.Trial Registration NumberClinical Trial Registry of Korea (KCT0004418).© American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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