TY - JOUR

T1 - Perineural and Systemic Dexamethasone and Ulnar Nerve Block Duration

T2 - A Randomized, Blinded, Placebo-controlled Trial in Healthy Volunteers

AU - Maagaard, Mathias

AU - Stormholt, Emma R.

AU - Nielsen, Lasse F.

AU - Bærentzen, Finn

AU - Danker, Jakob

AU - Zachodnik, Josephine

AU - Jæger, Pia

AU - Mathiesen, Ole

AU - Andersen, Jakob H.

N1 - Funding Information: The Department of Anesthesiology, Zealand University Hospital (Køge, Denmark) has received funding for other projects from The Novo Nordisk Foundation (Hellerup, Denmark) and Sygeforsikring DK (Copenhagen, Denmark), and conducted contract research for AM-Pharma (Utrecht, The Netherlands). The authors declare no other competing interests. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.

PY - 2023

Y1 - 2023

N2 - Background: The authors hypothesized that both perineural and systemic dexamethasone as adjuncts to bupivacaine increase the duration of an ulnar nerve block compared with bupivacaine alone, and that systemic dexamethasone is noninferior to perineural dexamethasone. Methods: The authors performed bilateral ulnar nerve blocks with 3 ml bupivacaine 5 mg/ml in 16 healthy volunteers on two trial days. According to randomization, subjects received adjunct treatment with 1 ml dexamethasone 4 mg/ml + 1 ml of saline (perineural condition) in one arm and 2 ml saline in the other arm (systemic condition, through absorption and redistribution of the contralaterally administered perineural dexamethasone) on one trial day; and 2 ml saline in one arm (placebo condition) and 2 ml of lidocaine in the other arm (lidocaine condition) on the other trial day. The primary outcome was the duration of the sensory nerve block assessed by temperature discrimination. Results: Mean sensory block duration was 706 ± 94 min for the perineural condition, 677 ± 112 min for the systemic condition, and 640 ± 121 min for the placebo condition. The duration of the sensory nerve block was greater with perineural dexamethasone versus placebo (mean difference 66 min (95% CI, 23 to 108). Block duration was similar between systemic dexamethasone and placebo (mean difference 36 min; 95% CI, -30 to 103). Conclusions: Perineural dexamethasone as an adjunct to bupivacaine in healthy volunteers resulted in a greater duration of an ulnar nerve block when compared with placebo. Systemic dexamethasone resulted in a similar duration as placebo.

AB - Background: The authors hypothesized that both perineural and systemic dexamethasone as adjuncts to bupivacaine increase the duration of an ulnar nerve block compared with bupivacaine alone, and that systemic dexamethasone is noninferior to perineural dexamethasone. Methods: The authors performed bilateral ulnar nerve blocks with 3 ml bupivacaine 5 mg/ml in 16 healthy volunteers on two trial days. According to randomization, subjects received adjunct treatment with 1 ml dexamethasone 4 mg/ml + 1 ml of saline (perineural condition) in one arm and 2 ml saline in the other arm (systemic condition, through absorption and redistribution of the contralaterally administered perineural dexamethasone) on one trial day; and 2 ml saline in one arm (placebo condition) and 2 ml of lidocaine in the other arm (lidocaine condition) on the other trial day. The primary outcome was the duration of the sensory nerve block assessed by temperature discrimination. Results: Mean sensory block duration was 706 ± 94 min for the perineural condition, 677 ± 112 min for the systemic condition, and 640 ± 121 min for the placebo condition. The duration of the sensory nerve block was greater with perineural dexamethasone versus placebo (mean difference 66 min (95% CI, 23 to 108). Block duration was similar between systemic dexamethasone and placebo (mean difference 36 min; 95% CI, -30 to 103). Conclusions: Perineural dexamethasone as an adjunct to bupivacaine in healthy volunteers resulted in a greater duration of an ulnar nerve block when compared with placebo. Systemic dexamethasone resulted in a similar duration as placebo.

U2 - 10.1097/ALN.0000000000004557

DO - 10.1097/ALN.0000000000004557

M3 - Journal article

C2 - 36912613

AN - SCOPUS:85159557986

VL - 138

SP - 625

EP - 633

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 6

ER -