Dose Response Study of Dexamethasone in Combination With Bupivacaine 0.25% (Dex Dose)

University of Pennsylvania

Status: Completed

Conditions: Post Surgical Pain

Treatments: Drug: Bupivacaine 0.25%; Drug: normal saline; Drug: Dexamethasone

Study type: Interventional

Funder types: Other

Identifiers

NCT01690663

815628

Details and patient eligibility

About

When used in conjunction with a local anesthetic, dexamethasone may prolong both the sensory and motor effects of high supraclavicular brachial plexus nerve block (SBP) in arthroscopic shoulder surgery. This study seeks to determine if there is a relationship between the duration of sensory and motor blockade in supraclavicular brachial plexus nerve blocks (SBP) when combined with increasing doses of dexamethasone.

Full description

The exact mechanism of dexamethasone on peripheral nerve block is unclear. The current theory is that the effect is not dose related, while only 4mg and 8mg doses were studied. Our hypothesis is that the dose differences at 1mg, 2mg, or 4mg, does not have significant effect on the duration of analgesia. Therefore, we are not considering any patients to receive suboptimal dosing of preservative free dexamethasone in this study.

Enrollment: 89 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Patients aged 18 to 70 scheduled for primary shoulder arthroscopy who have already elected to receive and are eligible for regional anesthesia (brachial plexus nerve block) prior to consenting for study.
2. Ability to sign informed consent.
3. Ability to follow study protocol, and speak, read and write in English.
4. Must have valid phone number for follow-up purpose.
5. Must be able to receive all protocol medications to include the dexamethasone, ketorolac, hydromorphone, and percocet.

Exclusion criteria

1. Patient younger than 18 years old and older than age 70
2. Patient refusal to sign consent
3. Chronic opioid use (defined as narcotic use longer than 3 months) as documented in patient's medical record
4. Allergy to any of the protocol medications
5. Patients with severe lung disease, contra lateral phrenic nerve injury, insulin-dependent diabetes, hepatic disease/failure, kidney disease/failure as documented in patient's medical record
6. Pregnancy (positive urine pregnancy test result in Preop area on morning of surgery)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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89 participants in 4 patient groups, including a placebo group

Bupivacaine 0.25% mixed with 1ml normal saline

Placebo Comparator group

Description:

Bupivacaine 0.25% mixed with 1ml normal saline (placebo/control group)

Treatment:

Drug: normal saline

Drug: Bupivacaine 0.25%

Bupivacaine 0.25% with 1mg dexamethasone (1ml)

Active Comparator group

Description:

Bupivacaine 0.25% mixed with 1mg preservative free dexamethasone (1ml)

Treatment:

Drug: Dexamethasone

Drug: Bupivacaine 0.25%

Bupivacaine 0.25% mixed with 2mg dexamethasone

Active Comparator group

Description:

Bupivacaine 0.25% mixed with 2mg preservative free dexamethasone (1ml)

Treatment:

Drug: Dexamethasone

Drug: Bupivacaine 0.25%

Bupivacaine 0.25% mixed with 4mg dexamethasone (1ml

Active Comparator group

Description:

Bupivacaine 0.25% mixed with 4mg preservative free dexamethasone (1ml

Treatment:

Drug: Dexamethasone

Drug: Bupivacaine 0.25%