Dexamethasone as an adjuvant to bupivacaine in brachial plexus block in upper limb surgery

Smita R. Engineer, Rahul Patel, Abhinav Bishnoi, Chetna M. Umrigar


Background: Supraclavicular brachial plexus block is widely used for surgery below shoulder joint. Adding adjuvant to local anesthetic drugs enhance the duration of block as well as postoperative analgesia. Dexamethasone very potent glucocorticoid when added to local significantly prolongs the duration of analgesia.

Methods: This randomized, single blind, controlled study include 100 patients of either sex, aged 18–60 years, ASA status I–III, undergoing upper limb surgery were randomly allocated to receive either 0.375% 30 cc bupivacaine with 2 ml normal saline (group C, n=50) or 0.375% bupivacaine with 2 ml (8 mg) dexamethasone (group D, n=50). The observed parameters include onset and duration of motor and sensory block, duration of effective analgesia any side effects and hemodynamic (pulse rate, NIBP, SpO2).  

Results: Mean onset time of sensory and motor block in group C was significantly longer as compared to group D. (p<0.0001) The duration of sensory and motor blockade was significantly prolonged in group D compared to group C. (p<0.0001) The duration of effective analgesia was also significantly prolonged in group D (931.2±69.88 mins) compared to group C (454.8±34.47 mins) (p<0.0001).

Conclusions: Addition of dexamethasone to 0.375% bupivacaine in brachial plexus block speeds the onset and prolongs the duration of sensory and motor blockade. It also prolongs the duration of effective analgesia. 


Dexamethasone, Bupivacaine, Brachial plexus block, Supraclavicular, Analgesia

Full Text:



Yadav RK, Shah BP, Kumar P, Singh SN. Effectiveness of addition of neostigmine or dexamethasone to local anesthetic in providing perioperative analgesia for brachial plexus block: A prospective, randomized, double blinded, controlled study. Kathmandu Univ Med J. 2008;23:302-9.

Cummings KC III, Napierkowksi DE, Parra-Sanchez, Kurz A, Dalton JE, Brems JJ, et al. Effect of dexamethasone on the duration of interscalene nerve block with ropivacaine or bupivacaine. British J Anaesthesia. 2011;107(3):446-53.

Islam SM, Hossain MHMD, Maruf AA. Effect of addition of dexamethasone to local anaesthetic in supraclavicular brachial plexus block. JAFMC Bangladesh. 2011;7:11-4.

Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102(1):263–7.

Talukdar M, Begum H, Shoman MM, Khatun UHS. Anaesthetic and analgesic effects of adding dexamethasone to bupivacaine in supraclavicular brachial plexus block–a comparative study. J Bangladesh Coll Physicians Surgeons. 2013;3:11-7.

Pathak RG, Anand PS, Rajendra NK. Supraclavicular brachial plexus block with and without Dexamethasone – A Comparative Study. Int J Sci Res Publ. 2012;12:1–7.

Parrington, Simon J, O'Donnell D, Chan VWS, Brown-Shreves D, Subramanyam R, et al. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Regional Anesthesia Pain Med. 2010;5:422-6.

Shrestha BR, Maharjan SK, Shrestha S, Gautam B, Thapa C, Thapa PB, et al. Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block. JNMA J Nepal Med Assoc. 2007;46(168):158–64.

McCormack K. The spinal actions of nonsteroidal anti-inflammatory drugs and the dissociation between their anti-inflammatory and analgesic effects. Drugs. 1994;47(5):28–45.

Ahlgren SC, Wang JF, Levine JD. C-fiber mechanical stimulus-response functions are different in inflammatory versus neuropathic hyperalgesia in the rat. Neuroscience. 1997;76(1):285–90.

Attali B, Latter H, Rachamim N, Garty H. A corticosteroid-induced gene expressing an “IsK-like” K+ channel activity in Xenopus oocytes. Proc Natl Acad Sci USA. 1995;92(13):6092–6.

Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48(11):961–4.

Shrestha BR, Maharjan SK, Tabedar S. Supraclavicular brachial plexus block with and without dexamethasone- a comparative study. Kathmandu Univ Med J. 2003;1(3):158–60.

Castillo J, Curley J, Hotz J, Uezono M, Tigner J, Chasin M, et al. Glucocorticoids prolong rat sciatic nerve blockade in vivo from bupivacaine microspheres. Anesthesiology. 1996;85(5):1157–66.

Rahman SM, Majumdar S, Das A, Saha TK, Bandyopadhyay SN, Mukherjee D, et al. Role of dexamethasone in supraclavicular brachial plexus block. J Dental Med Sci. 2013;12:1-7.

Holte K, Werner MU, Lacouture PG, Kehlet H. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers. Anesthesiology 2002;96(6):1331–5.

Kopacz DJ, Lacouture PG, Wu D, Nandy P, Swanton R, Landau C. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostal blockade (T9 to T11) in healthy volunteers. Anesth Analg. 2003;96(2):576–82.

Trabelsi W, Lebbi A, Romdhani C, Naas I, Sammoud W. Dexamethasone provides longer analgesia than tramadol when added to lidocaine after ultrasound guided supraclavicular brachial plexus block. A randomized, controlled, double blinded study. Analg Resusc Curr Res. 2013;6:2.

Benzon HT, Chew T-L, McCarthy RJ, Benzon HA, Walega DR. Comparison of the particle sizes of different steroids and the effect of dilution: a review of the relative neurotoxicities of the steroids. Anesthesiology. 2007;106(2):331–8.

Benzon HT, Gissen AJ, Strichartz GR, Avram MJ, Covino BG. The effect of polyethylene glycol on mammalian nerve impulses. Anesth Analg. 1987;66(6):553–9.

Latham JM, Fraser RD, Moore RJ, Blumbergs PC, Bogduk N. The pathologic effects of intrathecal betamethasone. Spine. 1997;22(14):1558–62.

Stahl S, Kaufman T. Ulnar nerve injury at the elbow after steroid injection for medial epicondylitis. J Hand Surg Br. 1997;22(1):69–70.

Aasboe V, Raeder JC, Groegaard B. Betamethasone reduces postoperative pain and nausea after ambulatory surgery. Anesth Analg. 1998;87(2):319–23.