• Ryung A Kang, Ji S Jeong, Jae C Yoo, Ju H Lee, Mi S Gwak, Soo J Choi, Tae S Hahm, Hyun S Cho, and Justin S Ko.
• Eur J Anaesthesiol. 2019 May 1; 36 (5): 360-368.

BackgroundIntravenous dexamethasone or dexmedetomidine is reported to prolong the duration of analgesia after single-shot interscalene brachial plexus block (ISBPB). However, the effect of co-administration of these agents on the duration of analgesia has not been evaluated.ObjectivesWe evaluated the difference in time to first rescue analgesic request between patients receiving co-administered intravenous dexamethasone and dexmedetomidine and patients receiving intravenous dexamethasone alone after single-shot ISBPB for arthroscopic shoulder surgery.DesignA randomised controlled study.SettingA single tertiary care centre, study period from August 2017 to January 2018.PatientsSixty-six patients undergoing arthroscopic shoulder surgery with ISBPB with 15 ml of 0.5% ropivacaine with 1 : 200 000 epinephrine.InterventionsWe randomly assigned the patients to one of three groups: intravenous 0.9% saline (control), intravenous dexamethasone 0.11 mg kg (D1 group), or co-administered intravenous dexamethasone 0.11 mg kg and intravenous dexmedetomidine 1.0 μg kg (D2 group).Main Outcome MeasuresThe primary outcome was the time to first rescue analgesic request.ResultsThe median [interquartile range] time to first rescue analgesic request was significantly longer for the D2 group (66.3 h [23.3 to 72]) than the D1 (17.4 h [14.9 to 36], P = 0.002) and control (10.9 h [10.1 to 12.2], P < 0.001) groups. The D1 and D2 groups both had reduced pain scores, reduced postoperative opioid consumption, less sleep disruption and improved patient satisfaction compared with the control group. There were no significant elevations in blood glucose concentrations in patients receiving dexamethasone (D1 and D2 groups) compared with the control group at postoperative day 1.ConclusionCo-administration of intravenous dexamethasone (0.11 mg kg) with dexmedetomidine (1.0 μg kg) significantly prolonged the time to first rescue analgesic request after single-shot ISBPB in patients undergoing arthroscopic shoulder surgery.Trial RegistrationClinical Trial Registry of Korea; https://cris.nih.go.kr/cris/index.jsp and identifier: KCT0002569.

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