• Julian Aliste, Prangmalee Leurcharusmee, Phatthanaphol Engsusophon, Aida Gordon, Giuliano Michelagnoli, Chonticha Sriparkdee, Worakamol Tiyaprasertkul, Dana Q Tran, Tom C R V Van Zundert, Roderick J Finlayson, and De Q H Tran.
• Department of Anesthesia, Montreal General Hospital, McGill University, 1650 Ave Cedar, D10-144, Montreal, QC, H3G 1A4, Canada.
• Can J Anaesth. 2017 Jan 1; 64 (1): 29-36.

BackgroundThis randomized double-blinded trial compared the effect of intravenous and perineural dexamethasone (8 mg) on the duration of motor block for ultrasound (US)-guided axillary brachial plexus block (AXB).MethodsPatients undergoing upper limb surgery with US-guided AXB were randomly allocated to receive preservative-free dexamethasone (8 mg) via intravenous (n = 75) or perineural (n = 75) administration. The local anesthetic agent, 1% lidocaine -0.25% bupivacaine (30 mL) with epinephrine 5 µg·mL(-1), was identical in all subjects. Operators and patients were blinded to the nature of the intravenous and perineural injectate. A blinded observer assessed the block success rate (i.e., a minimal sensorimotor composite score of 14 out of 16 points at 30 min), block onset time, as well as the presence of surgical anesthesia. Postoperatively, the blinded observer contacted all patients with successful blocks to record the duration of motor block (primary outcome), sensory block, and postoperative analgesia.ResultsNo intergroup differences were observed in terms of success rate, surgical anesthesia, and block onset time. Compared to intravenous administration, perineural dexamethasone provided longer mean (SD) durations for motor block [17.5 (4.6) hr vs 12.8 (4.5) hr; mean difference, 4.6 hr; 95% confidence interval [CI], -6.21 to -3.08; P < 0.001], sensory block [17.7 (5.1) hr vs 13.7 (5.0) hr; mean difference, 4.0 hr; 95% CI, -5.77 to -2.27; P < 0.001], and postoperative analgesia [21.1 (4.6) hr vs 17.1 (4.6) hr; mean difference, 4.0 hr; 95% CI, -5.70 to -2.30; P < 0.001].ConclusionCompared to intravenous dosing, perineural dexamethasone (8 mg) results in longer durations of sensorimotor block and postoperative analgesia for ultrasound-guided axillary block. This trial was registered at www.clinicaltrials.gov number, NCT02629835.

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