الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pain is the most complex human experience. Perioperative pain is more distressing to the patient and is also much more difficult to relief adequately.
Brachial plexus nerve blocks (BPBs) for upper extremity surgery
provide superior analgesia and reduce opioid consumption. Painful procedures previously requiring inpatient hospital admission for pain control are now commonly performed as ambulatory procedures facilitated by BPB analgesia.
When compared to other approaches of BPB, ICB provides comprehensive anesthesia of the upper limb with lower risk of inadvertent lung or pleural puncture.
A variety of local anesthetic adjuncts have been studied in an attempt to prolong the effects of single-injection peripheral nerve blockade. Among these adjuncts, dexamethasone has gained considerable interest several studies have reported that dexamethasone prolongs the analgesic duration of SISB regardless of the route of administration
Ultrasound has become the cornerstone of peripheral nerve blocks in upper limb surgeries. It provides better visualisation of the LA spread, reduces the LA dose and improves the quality of block.
The aim of this study was to compare the effect of perineural versus intravenous dexamethasone on the outcomes of a single-shot US-guided ICB with plain bupivacaine 0.5% in upper limb surgeries below the shoulder as regards hemodynamic parameters, onset and duration of the block and postoperative analgesic requirements.
This study was carried out at Alexandria Main University Hospitals on 44 ASA I & II adult patients scheduled for elective upper limb surgeries below the shoulder using US-guided ICB. Patients were equally randomized into 2 groups (22 each);
group I: Patients received 20 mL of plain bupivacaine 0.5% plus 2 mL (8mg) of dexamethasone perineurally (group PN).
group II: Patients received 20 mL of plain bupivacaine 0.5% and 2 mL (8mg) IV dexamethasone (group IV).
Preoperative evaluation was done by complete history taking, clinical examination and necessary laboratory investigations. All patients were informed about the procedure and taught how to use the VAS for assessing pain.
On arrival to the operating room, patients were connected to the standard monitoring; electrocardiograph, non-invasive arterial blood pressure and pulse oximetry. All patients were premedicated with IV midazolam (0.05mg.kg-1).
The patients were positioned in the supine position with the head turned away from the side to be blocked, the arm abducted to 90° and the elbow flexed.
On the proposed side of operation, under strict aseptic precautions and after infiltration with local anesthetic at the needle insertion site, all the patients received US-guided ICP, and the operation started after the assessment of block.
The following parameters were measured:
• Demographic data: age (years), gender (sex), body weight (kg), duration of the operation performed.
• Vital signs: e.g. heart rate, Mean arterial blood pressure, respiratory rate and oxygen saturation. All previous parameters were measured preoperative, after block, every 30 minutes till the end of surgery and then every 4 hours for the next 24 postoperative hours constituting the study period.
• Onset of sensory block by loss of cold sensation with ice pack.
• Onset of motor block by loss of flexion of index and middle fingers.
• NVPS and VAS assessment were recorded immediately postoperative, every 2 hours for the first 12 hours, then every 4 hours for the next 12 hours.
• Duration of analgesia (minutes)
• Total dose of rescue analgesia (milligrams)
• Complications of the block: e.g. local anesthetic toxicity, hematoma at site of injection, pneumothorax and any other associated complications.
There was no significant difference between both groups as regards age, sex, weight and duration of the surgery.
HR, MABP and RR were significantly lower in group PN at 16 hours when compared to group IV.
There was no significant difference between the two groups as regards the oxygen saturation.
The NVPS at 16 hours was significantly lower in group PN than in group IV (p= <0.002).
There was a statistical significant high VAS value in group IV when compared with group PN at 16 hours after the operation (p= <0.001).
There was a statistical significant increase in the duration of analgesia in group PN when compared to group IV (p= <0.001).
There was a statistical significant increase in the opioid analgesic requirements in group IV when compared to group PN (p= 0.001).
There was no significant difference between the two groups as regard rate of complications of the block.