Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial
Background: Rebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic wh...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001424000976 |
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| author | Layana Vieira Nobre Leonardo Henrique Cunha Ferraro Juscelino Afonso de Oliveira Júnior Vitória Luiza Locatelli Winkeler Luis Flávio França Vinhosa Muniz Hiago Parreão Braga Plínio da Cunha Leal |
| author_facet | Layana Vieira Nobre Leonardo Henrique Cunha Ferraro Juscelino Afonso de Oliveira Júnior Vitória Luiza Locatelli Winkeler Luis Flávio França Vinhosa Muniz Hiago Parreão Braga Plínio da Cunha Leal |
| author_sort | Layana Vieira Nobre |
| collection | DOAJ |
| description | Background: Rebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain. Methods: This was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure. Results: The incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain. Conclusion: The administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain. |
| format | Article |
| id | doaj-art-0a251a93cb16424ebbb5bb4823ab122f |
| institution | Kabale University |
| issn | 0104-0014 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj-art-0a251a93cb16424ebbb5bb4823ab122f2025-02-01T04:11:32ZengElsevierBrazilian Journal of Anesthesiology0104-00142025-01-01751844575Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trialLayana Vieira Nobre0Leonardo Henrique Cunha Ferraro1Juscelino Afonso de Oliveira Júnior2Vitória Luiza Locatelli Winkeler3Luis Flávio França Vinhosa Muniz4Hiago Parreão Braga5Plínio da Cunha Leal6Hospital Geral de Fortaleza (HGF), Departamento de Anestesiologia, Fortaleza, CE, BrazilUniversidade Federal de São Paulo (UNIFESP), Departamento de Anestesiologia, São Paulo, SP, BrazilHospital Universitário Cajuru, Departamento de Anestesiologia, Curitiba, PR, BrazilHospital Universitário Cajuru, Departamento de Anestesiologia, Curitiba, PR, BrazilUniversidade Federal de Goiás (UFG), Departamento de Anestesiologia, Goiânia, GO, BrazilHospital São Domingos, Departamento de Anestesiologia, São Luis, MA, BrazilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde do Adulto, São Luis, MA, Brazil; Corresponding author.Background: Rebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain. Methods: This was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure. Results: The incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain. Conclusion: The administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain.http://www.sciencedirect.com/science/article/pii/S0104001424000976Brachial plexus blockClonidineDexamethasonePain |
| spellingShingle | Layana Vieira Nobre Leonardo Henrique Cunha Ferraro Juscelino Afonso de Oliveira Júnior Vitória Luiza Locatelli Winkeler Luis Flávio França Vinhosa Muniz Hiago Parreão Braga Plínio da Cunha Leal Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial Brazilian Journal of Anesthesiology Brachial plexus block Clonidine Dexamethasone Pain |
| title | Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial |
| title_full | Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial |
| title_fullStr | Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial |
| title_full_unstemmed | Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial |
| title_short | Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial |
| title_sort | efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery a randomized clinical trial |
| topic | Brachial plexus block Clonidine Dexamethasone Pain |
| url | http://www.sciencedirect.com/science/article/pii/S0104001424000976 |
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