# A Prospective, Randomized Comparative Study of Intravenous and Perineural Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Supraclavicular Brachial Plexus Block for Adult Patients Undergoing Elective Upper Limb Surgery

## TL;DR

This study compares two ways of giving dexamethasone during anesthesia for arm surgery and finds that giving it near the nerve works better than through the vein.

## Contribution

The study provides new evidence that perineural dexamethasone improves block effectiveness more than intravenous administration.

## Key findings

- Perineural dexamethasone led to faster onset and longer duration of sensory and motor block.
- Postoperative analgesia was significantly longer with perineural dexamethasone.
- No serious complications were observed in either group.

## Abstract

Background

Ultrasound-guided supraclavicular brachial plexus block is a widely used regional anesthesia technique for upper limb surgeries, offering effective intraoperative and postoperative analgesia. Dexamethasone, a corticosteroid with analgesic and anti-inflammatory properties, is often used as an adjuvant via either the perineural or the intravenous route to prolong block duration. This study aimed to compare the efficacy of intravenous versus perineural dexamethasone as adjuvants to levobupivacaine in ultrasound-guided supraclavicular blocks.

Methods

A prospective, randomized, double-blind study was conducted at Sardar Vallabh Bhai Patel Hospital, Meerut, over 18 months. Sixty American Society of Anesthesiologists (ASA) I/II adult patients aged 18-60 years undergoing elective upper limb surgeries were randomly allocated into two equal groups. Group A received 19 mL of 0.5% levobupivacaine with 1 mL of normal saline perineurally and 4 mg (1 mL) of intravenous dexamethasone. Group B received 19 mL of 0.5% levobupivacaine with 4 mg (1 mL) of perineural dexamethasone and 1 mL of intravenous saline. Block performance and drug preparation were done under sterile conditions using ultrasound guidance. Primary outcomes included onset and duration of sensory and motor block. Secondary outcomes were postoperative analgesia duration, hemodynamic changes, pain scores, and complications.

Results

Perineural dexamethasone (Group B) resulted in significantly faster onset and longer duration of sensory and motor block compared to intravenous administration (Group A) (p < 0.05). The duration of postoperative analgesia was also significantly prolonged in Group B. Hemodynamic parameters remained stable in both groups, and no serious complications were observed.

Conclusion

Perineural dexamethasone is more effective than intravenous dexamethasone in enhancing the onset and duration of levobupivacaine-induced supraclavicular brachial plexus block. It also provides superior postoperative analgesia without increasing adverse effects. It is recommended as the preferred route for dexamethasone administration in upper limb surgeries.