Objectives: The present study aimed to evaluate the competence of infraclavicular brachial plexus block (rCB)
for patients assigned for hand and forearm surgen) and the effects of using a combination of dexamethasone and
local anesthetic for block
Patients & Methods : TIlis study included 40 ASA 1 and II patients randomly allocated into 2 groups: Control group received 38 ml of lidocaine 1.5% and 2 ml normal saline and Study group received 38 ml of lidocaine 1.5% mixed with 2 ml (8 mg) dexamethasone. All blocks were performed using a nerve stimulator and an insulated needle depending on provocation of a distal motor response in the hand or the wrist. The sensory block was assessed and degree ofsenson) block was evaluated on 3-point scale with O=no sensation to 2=normal sensation. A successful. block was defined as sensory block score=O in the four major nerve distributions; for incomplete block, selective supplementation at the humeral canal was perfonned but if more than 2 nerves remained unblocked, the procedure was considered failed and general anesthesia was performed. Block performance time; latency time, duration of analgesia and degree of motor block were evaluated. Procedure related complications and patient satisfaction with anesthetic technique were assessed.
Results: The block was successful in 27 patients but totally failed with shift to general anesthesia in 5 patients and in 8 patients the response was incomplete block with a total success rate of 87,5%. TIle mean block performance time of rCB showed non-significant difference between both studied groups. However, dexamethasone combination significantly reduced latency time and provided Significantly longer duration of senson) and motor block in comparison to control group. However, mean motor block scores and VAS of discomfort during rCB showed a non-significant difference between both groups. Six patients; 4 in control and 2 in study groups, refused to repeat tile procedure once again with a satisfaction rate of 85%, Adverse effects were encountered in 2 patients (5%) with a non-significant difference between both groups.
Conclusion : ft could be concluded that infraclavicular brachial plexus block is an appropriate anestlletic modality for hand and forearm surgen) with procedural success rate of 87.5% and combination of local anestlletic with dexamethasone improved its outcome in the form of significantly shorter latency time and prolonged postoperative analgesia with higher patients I satisfaction rate. |
