• Jiabin Liu, Kenneth A Richman, Samuel R Grodofsky, Siya Bhatt, George Russell Huffman, John D Kelly, David L Glaser, and Nabil Elkassabany.
• Department of Anesthesiology and Critical Care, the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 19104. Electronic address: Jiabin.liu@uphs.upenn.edu.
• J Clin Anesth. 2015 May 1;27(3):237-42.

Study ObjectiveThe study objective is to examine the analgesic effect of 3 doses of dexamethasone in combination with low concentration local anesthetics to determine the lowest effective dose of dexamethasone for use as an adjuvant in supraclavicular brachial plexus nerve block.DesignThe design is a prospective randomized double-blinded clinical study.SettingThe setting is an academic medical center.PatientsThe patients are 89 adult patients scheduled for shoulder arthroscopy.InterventionsAll patients were randomly assigned into 1 of 4 treatment groups: (i) bupivacaine, 0.25% 30 mL; (ii) bupivacaine, 0.25% 30 mL with 1-mg preservative-free dexamethasone; (iii) bupivacaine, 0.25% 30 mL with 2-mg preservative-free dexamethasone; and (iv) bupivacaine, 0.25% 30 mL with 4-mg preservative-free dexamethasone. All patients received ultrasound-guided supraclavicular brachial plexus nerve blocks and general anesthesia.MeasurementsThe measurements are the duration of analgesia and motor block.Main ResultsThe median analgesia duration of supraclavicular brachial plexus nerve block with 0.25% bupivacaine was 12.1 hours; and 1-, 2-, or 4-mg dexamethasone significantly prolonged the analgesia duration to 22.3, 23.3, and 21.2 hours, respectively (P = .0105). Dexamethasone also significantly extended the duration of motor nerve block in a similar trend (P = .0247).ConclusionLow-dose dexamethasone (1-2 mg) prolongs analgesia duration and motor blockade to the similar extent as 4-mg dexamethasone when added to 0.25% bupivacaine for supraclavicular brachial plexus nerve block.Copyright © 2015 Elsevier Inc. All rights reserved.

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