Dexamethasone versus Ketorolac as Adjuvants to Interscalene Brachial Plexus Block in Shoulder Arthroscopy Under General Anesthesia

Abstract Background: The ultrasound guided Interscalene Brachial Plexus Block (IBPB) when used combined with general anesthesia has several advantages for patients scheduled for shoulder surgery. These advantages include, good control of intraoperative hemodynamics, and adequate management of postoperative pain.
Aim and Objective: This study compares the effect of adding dexamethasone versus ketorolac to bupivacaine and lidocaine mixture in US guided IBPB regarding postoperative analgesia and intraoperative hemodynamics in patients under-going shoulder arthroscopy.
Patients and Methods: This prospective randomized, controlled study was done in Assiut University Hospitals from February 2016 to January 2017. It was approved by Asyut University Ethics Committee, and a written informed consent was obtained from all patients. Sixty patients were enrolled in the study with the following inclusion criteria, ASA I-II, age 18-60 years, scheduled for elective shoulder arthroscopy in Asyut University Hospital. Patients were indiscriminately distributed to three groups: - Group [C] (control group) received 25ml solution: 10ml lidocaine 1%, 10ml bupivacaine 0.25% and 5mL of normal saline 0.9%. - Group [D] (dexamethasone group) received 25ml solution: 10ml lidocaine 1%, 10ml bupivacaine 0.25% and 5mL of dexamethasone (5mg). - Group [K] (Ketorolac group) received 25ml solution: 10ml lidocaine 1%, 10ml bupivacaine 0.25% and 5mL of ketorolac (10mg/ml) (50mg).
Sensory and motor block onset in minutes, intensity of post-operative pain assessed by Visual Analogue Score (VAS), duration of post-operative analgesia, and intraoperative he-modynamics were documented and compared between the groups. Results: We founded that the duration of post-operative analgesia including the time for the first analgesic requirement was significantly longer in dexamethasone group with average 13.7±2 hours while it was 10.95±1.05 in ketorolac group and 11.7±3.53 in control group with. Total Rescue analgesia administration was much less in dexamethasone group in comparison with other groups but all groups did not need any additional opioid in the first day postoperative.
Conclusion: Dexamethasone provides better post-operative pain relief than ketorolac when added to mixture of lidocaine and bupivacaine in ultrasound guided interscalene block for shoulder arthroscopy under general anesthesia.