Korean J Pain.  2018 Oct;31(4):261-267. 10.3344/kjp.2018.31.4.261.

Comparison of 4 mg dexamethasone versus 8 mg dexamethasone as an adjuvant to levobupivacaine in fascia iliaca block-a prospective study

• Acharya R
• Sriramka B
• Panigrahi

• KMID: 2421517
• DOI: http://doi.org/10.3344/kjp.2018.31.4.261

Abstract

BACKGROUND
To compare the effects of adding two different doses of dexamethasone on the duration and quality of the fascia iliaca block in patients undergoing proximal femoral fracture surgery.
METHODS
A total of 60 patients (age 18-70 years) undergoing proximal femoral nailing surgery under spinal anesthesia were given fascia iliaca block after random assignment to one of the two groups: Group H received an injection of levobupivacaine (0.5%) 28 ml with 2 ml (8 mg) dexamethasone, and Group L received an injection of levobupivacaine (0.5%) 28 ml with dexamethasone 1 ml (4 mg) with 1 ml normal saline. Assessment of the duration of analgesia and the total tramadol requirement over 48 hours were noted after a successful block.
RESULTS
The duration of analgesia was found to be significantly longer in Group H (17.02 ± 0.45 h) than in the Group L patients (14.29 ± 0.45 h) with a p-value of 0.000. Postoperative analgesic requirement (amount of tramadol in mg) was significantly higher in Group L (Q2: 200.0; IQR: 100.0, 200.0) as compared to Group H (Q2: 100.0; IQR: 100.0, 200.0) with a p-value of 0.034. No patient showed any sign of neurotoxicity.
CONCLUSIONS
Dexamethasone, in a dose of 8 mg, is superior to 4 mg when used as an adjuvant with levobupivacaine in the FIB. Though both prolonged analgesia and were effective in reducing oral/intravenous analgesics, 8 mg dexamethasone can be recommended as a more efficacious adjuvant to local anesthetics in the FIB.

Keyword

Analgesia; Bupivacaine; Dexamethasone; Fascia; Femoral fractures; Levobupivacaine; Local anesthetics; Pain management; Spinal anesthesia; Tramadol

MeSH Terms

Analgesia
Analgesics
Anesthesia, Spinal
Anesthetics, Local
Bupivacaine
Dexamethasone*
Fascia*
Femoral Fractures
Humans
Pain Management
Prospective Studies*
Tramadol
Analgesics
Anesthetics, Local
Bupivacaine
Dexamethasone
Tramadol

Figure

• 

  Fig. 1 Ultrasound images. (A) Ultrasound image showing Sartorius muscle and Iliacus muscle with overlying fascia iliaca, (B) Ultrasound image showing in plane needle technique through fascia iliaca and the fascia may be seen to snap back (hollow arrow pointing). (C) Ultrasound image showing plane between fascia and iliopsoas muscle being separated by 1 ml of solution (hollow arrow pointing). (D) Ultrasound image showing drug spread and separation of fascia iliaca (hollow arrows pointing).

• 

  Fig. 2 Consolidated Standards of Reporting Trials (CONSORT) flow diagram of participants.

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