Efficacy of Dexamethasone and Fentanyl as an Adjuvant with LignocaineAdrenaline and Bupivacaine for Supraclavicular Brachial Plexus Block in Upper Limb Surgery

Author(s): Mahabubuzzaman M, Begum SA, Iqbal MJ, Kumar D, Islam MS, Bhowmick LK, Kaisar K, Rahman AKMS

Supraclavicular Brachial Plexus Block (SCBB) has become one of the most important anaesthesia techniques for upper limb surgeries. It also provides analgesia during postoperative period. An adjuvant can prolong the action of local anaesthetics after single injection of SCBB. This study was designed to evaluate the effectiveness of dexamethasone and fentanyl as an adjuvant for postoperative analgesia with Lignocaine- Adrenaline and Bupivacaine in SCBB among patients underwent upper limb surgery. This randomized controlled trial was carried out at Department of Anaesthesia and Intensive Care Medicine, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh. A total of 90 patients were enrolled. All study patients were allocated into three groups and each group was consisted 30 patients: Group-A received local anaesthetic with adrenaline solution; Group-B received local anaesthetic solution with adrenaline and fentanyl; Group-C received local anaesthetic solution with adrenaline and dexamethasone. SCBB was done with the ultrasound guidance. It was observed that, the required time onset of sensory and motor blocks were less in group B. But the duration of sensory and motor blocks were prolonged in group C. The time for 1st rescue analgesic within 24 hours and total analgesic requirements were less in group C. The side effects like dyspnoea or chest discomfort, nausea, itching and shivering were less in group C. This study concluded that both dexamethasone and fentanyl are able to prolong duration of analgesia in SCBB, but dexamethasone is better as it provides analgesia for prolong periods with less complication during peri-operative period.