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Ropivacaine Block Alone or With Perineural or Systemic Dexamethasone for Pain in Shoulder Surgery

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Mayo Clinic

Status and phase

Completed
Phase 4

Conditions

Shoulder Injury

Treatments

Drug: Ropivacaine
Drug: Normal saline
Drug: Dexamethasone

Study type

Interventional

Funder types

Other

Identifiers

NCT01450007
11-001266

Details and patient eligibility

About

Pre-operative perineural injection of dexamethasone mixed with local anesthetic in peripheral nerve blockade for orthopedic surgery has been shown to prolong the length of analgesia, improve visual analog pain scores, decrease post-operative opioid use, and decrease post-operative nausea. No study has been published to determine if this effect is a result of systemic absorption of dexamethasone or is a local effect of the drug on neuronal activity at the injection site. This study is a prospective, randomized, double-blind, controlled study to compare pain block with (1) ropivacaine and saline plus intravenous saline vs (2) ropivacaine and dexamethasone plus intravenous saline vs (3) ropivacaine and saline plus intravenous dexamethasone. Patients will be recruited sequentially and assigned to the three groups at random in equal ratios. The hypothesis is that dexamethasone injected perineurally in combination with ropivacaine for interscalene brachial plexus block will yield longer duration of sensory blockade as compared to ropivacaine alone without intravenous or perineural dexamethasone and as compared to ropivacaine and intravenous dexamethasone. This result will suggest that the effect of dexamethasone is a result of direct neuronal activity at the injection site versus systemic absorption.

Enrollment

130 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  1. Patients undergoing elective shoulder surgery by one of two surgeons highly experienced in the procedure.
  2. Patients are either: Opioid naïve; or Have not taken opiates for one month prior to surgery (tramadol is permissible).
  3. Patients have an American Society of Anesthesiology physical status I-III.

Exclusion criteria

  1. Females who are pregnant.
  2. Patients who are taking chronic daily opiates for one month prior to surgery except tramadol.
  3. Diabetic patients.
  4. Patients with creatinine above 1.1mg/dL for females and above 1.3mg/dL for males.
  5. Patients with contralateral pneumothorax or diaphragmatic paralysis.
  6. Patients with coagulopathy.
  7. Patients with clinically significant previous nerve injury in surgical extremity.
  8. Patients with an allergy to NSAIDs.
  9. Patients who are refusing a block.
  10. Patients with a contraindication to ropivacaine, dexamethasone, or interscalene block due to other medical condition such as severe chronic obstructive pulmonary disease (COPD).

Trial design

Primary purpose

Supportive Care

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Quadruple Blind

130 participants in 3 patient groups, including a placebo group

Dexamethasone block
Experimental group
Description:
Blockade with 25 ml ropivacaine 0.5% mixed with 8 mg dexamethasone (0.8 ml), and 5 ml intravenous normal saline
Treatment:
Drug: Normal saline
Drug: Dexamethasone
Drug: Dexamethasone
Drug: Ropivacaine
Drug: Normal saline
Dexamethasone IV
Active Comparator group
Description:
Blockade with 25 ml ropivacaine 0.5% mixed with 0.8 ml normal saline, and intravenous 8 mg dexamethasone (0.8 ml dexamethasone, 4.2 ml saline) to total volume of 5 ml
Treatment:
Drug: Normal saline
Drug: Dexamethasone
Drug: Dexamethasone
Drug: Ropivacaine
Drug: Normal saline
Placebo
Placebo Comparator group
Description:
Blockade with 25 ml ropivacaine 0.5% mixed with 0.8 ml normal saline, and 5 ml intravenous normal saline
Treatment:
Drug: Normal saline
Drug: Ropivacaine
Drug: Normal saline

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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