Comparison of Dexamethasone and Ketorolac as an Adjuvant to Bupivacaine in Axillary Brachial Plexus Blocks for Isolated Hand and Forearm Injuries: A Randomised Double-Blind Prospective Study UC05-UC09
Dr. Rathna Paramaswamy,
Professor and Head, Department of Anaesthesiology, Saveetha Medical College and Hospital,
Chennai-602105, Tamil Nadu, India.
Introduction: Brachial plexus nerve blocks for upper limb surgery provide superior analgesia and reduce opioid consumption. Dexamethasone has been an effective adjuvant to local anaesthetics in brachial plexus block but there are very less studies with ketorolac.
Aim: To compare the duration of analgesia and block characteristics with dexamethasone versus ketorolac as an adjuvant to bupivacaine in axillary plexus blocks.
Materials and Methods: This randomised double-blinded study was conducted on 120 patients with isolated hand and forearm injuries who were divided into three equal groups. Ultrasound guided axillary brachial plexus block was performed in patients in Group C with 30 mL of 0.375% bupivacaine plus 2 mL of normal saline, Group D with 30 mL of 0.375% bupivacaine plus 8 mg dexamethasone and Group K with 30 mL of 0.375% bupivacaineplus 30 mg ketorolac. The onset, duration of sensory and motor block and total duration of analgesia were recorded for each patient. Analysis of variance and student’s t-tests were used for statistical comparisons.
Results: The duration of sensory block was 389.75±40.35 minutes in Group C, 909.25±76.74 minutes in Group D and 651.50±75.77 minutes in Group K. The total duration of motor block was 281.75±38.68 minutes in Group C, 522.00±53.74 minutes in Group D and 426.00±60.07 minutes in Group K. The time to first rescue analgesic was 570.00±0.197.37 minutes in Group C, 1260.0±184.93 minutes in Group D and 964.61±190.41 minutes in Group K (p<0.001).
Conclusion: Dexamethasone and ketorolac as adjuvant to bupivacaine in axillary plexus blocks significantly prolonged analgesia and duration of motor and sensory block. These effects were more enhanced with dexamethasone than ketorolac.