Perineural Low-Dose Dexamethasone Prolongs Interscalene Block Analgesia With Bupivacaine Compared With Systemic Dexamethasone: A Randomized Trial

Background and Objectives Perineural dexamethasone and intravenous (IV) dexamethasone have been shown to prolong peripheral nerve block duration. The effects of perineural and IV dexamethasone have only been compared at doses of 4 mg or greater. This triple-blind, randomized trial examined the effect of 1 mg IV versus perineural dexamethasone on interscalene block (ISB) analgesia duration. Methods Patients undergoing ambulatory shoulder arthroscopy received an ultrasound-guided ISB with 15 mL bupivacaine 0.5% and 1 mg preservative-free dexamethasone that was administered perineurally (PeriD) or IV (IVDex). All patients received IV ketorolac and were discharged on naproxen 500 mg 2 times a day plus oxycodone/acetaminophen as needed. Peripheral nerve block duration, pain, opioid consumption, and block satisfaction were assessed via telephone follow-ups. Results There were 63 PeriD patients and 62 IVDex patients who completed the primary outcome follow-up. The median time until analgesia from the ISB completely wore off was 3.5 hours (95% confidence interval, 1.0–6.0 hours) longer in the PeriD versus IVDex groups; P = 0.007). Time until the pain relief from the ISB began to wear off was also longer in the PeriD versus IVDex group (5.5 hours [95% confidence interval, 2.1–9.0 hours]; P = 0.002). Other secondary outcomes, including opioid consumption, satisfaction, and pain scores, were not different between groups. Conclusions In patients undergoing shoulder arthroscopy, low-dose perineural dexamethasone (1 mg) in combination with 15 mL of 0.5% bupivacaine prolonged the median time until pain relief from the ISB completely wore off compared with 1 mg IV dexamethasone. However, the degree of prolongation was smaller than the a priori–defined minimal clinically meaningful difference of 5 hours. Clinical Trial Registration This study was registered at Clinicaltrials.gov, identifier NCT02506660. Accepted for publication February 12, 2018. Address correspondence to: Richard L. Kahn, MD, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail: KahnR@HSS.edu). This study was funded by East River Medical Associates and the Research and Education Fund, Anesthesiology Department, Hospital for Special Surgery, New York, NY. REDCap use was supported by the National Center for Advancing Translational Science of the National Institutes of Health (UL1TR000457). This was presented in part at the Society for Ambulatory Anesthesia 32nd Annual Meeting (May 4–6, 2017) in Scottsdale, AZ. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Harnessing immune history to combat influenza viruses

Jenna J Guthmiller | Patrick C Wilson

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Editorial Board

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A novel punch biopsy technique without scissors or forceps

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Rituximab Treatment Of Pemphigus Foliaceus- A Retrospective Study Of 12 Patients

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Radiographic study to assess the reliability of the Gillies approach for biopsy of the superficial temporal artery

Biopsy of the superficial temporal artery is often used in the diagnosis of giant cell arteritis, but at traditional sites there is a risk of injury to the facial nerve. Recently the Gillies incision has been suggested as an alternative means of access for the biopsy, but the anatomical basis of this has not been fully elucidated. We therefore undertook a radiographic review of 150 patients, and examining 300 vessels, to find out. Our results indicated that there is considerable variability in the position of the bifurcation of the superficial temporal artery, and so a Gillies approach may not be reliable, particularly if access to the bifurcation is required.

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Digital cutting guide and endoscopically-assisted vertical ramus osteotomy to treat condylar osteochondroma: a long-term study

We have introduced an effective treatment for mandibular condylar osteochondroma with a digital cutting guide and endoscopically-assisted vertical ramus osteotomy (VRO). Eleven patients with unilateral condylar osteochondroma, who did not require orthognathic surgery or had less than 3mm deviation of the chin and a stable occlusion, were treated during the period April 2013–January 2017 with a digital cutting guide and endoscopically-assisted VRO. Clinical data collected included the occlusion, facial contour, and maximum mouth opening (MMO).

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