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PERINEURAL DEXAMETHASONE ADDED TO SCIATIC NERVE BLOCK PROLONGS ANALGESIA AFTER MAJOR FOOT AND ANKLE SURGERY. A RANDOMISED DOUBLE-BLINDED CONTROLLED TRIAL
ESRA Academy. Hauritz R. Sep 8, 2016; 138377; 0217 Topic: Adjuvant Drugs
Dr. Rasmus Wulff Hauritz
Dr. Rasmus Wulff Hauritz

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Abstract
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Background and Aims:

Major ankle surgery is associated with severe postoperative pain. Sciatic nerve block combined with saphenous nerve block provides effective analgesia after major foot and ankle surgery. Perineural adjunct of dexamethasone with the local anaesthetic consistently prolongs block duration. However, prolongation of popliteal sciatic nerve block associated with dexamethasone adjunct block needs further investigation. We aimed to estimate the duration of postoperative analgesia in patients undergoing major foot and ankle surgery randomised to popliteal sciatic nerve block with either Dexamethasone or saline added to Bupivacaine-Epinephrine.

Methods:

56 patients scheduled for major ankle surgery were randomly allocated to a sciatic nerve block with a mixture of 18 mL Bupivacaine (0.5%)-Epinephrine (1:200.000) with the addition of either 2 mL of Dexamethasone (4 mg/ml) or 2 mL of saline (9 mg/ml). Patients received sciatic nerve block combined with a saphenous nerve block preoperatively and were postoperatively monitored with repetitive patient-blinded test for motor and pinprick sensation along with pain scores in 30 minutes’ intervals until complete loss of block efficacy. Primary outcome was time until complete recovery of toe sensory and motor function.

Results:

Preliminary results showed a significantly prolongation of block duration in the Dexamethasone group vs. the placebo group. Total equipotent oral morphine dose in the 0-24 hrs. as well as the 24-48 hrs. intervals were significantly reduced for the Dexamethasone group.

Conclusions:

Dexamethasone (8 mg) added to 0.5% Bupivacaine-Epinephrine significantly prolongs the duration of sensory and motor block in patients scheduled for major foot and ankle surgery with popliteal sciatic nerve block.

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