Efficacy of Dexamethasone versus Dexmedetomidine Combined with Local Anaesthetics in Brachial Plexus Block: A Meta-Analysis and Systematic Review

Local ozone injection compared to local glucocorticoid injection in carpal tunnel syndrome: A randomized controlled trial

Objectives

This study aimed to compare the effectiveness of local ozone (O3) injection versus corticosteroid injection in the treatment of mild to moderate carpal tunnel syndrome (CTS).

Patients and methods

This double-blind randomized controlled trial was performed on 42 patients (9 males, 33 females; mean age: 46.7±2.1 years; range, 18 to 70 years) with mild to moderate CTS between May 2021 and June 2021. The corticosteroid group (n=21) was injected with 40 mg triamcinolone, and in the O3 group B (n=21), 4 mL of a 10 mcg/mL oxygen (O2)-O3 mixture was injected. Symptom severity and functional impairments were assessed using a Visual Analog Scale and Boston Carpal Tunnel Questionnaire. Electrodiagnostic and ultrasonographic parameters were obtained at baseline and eight weeks after the procedure.

Results

The O2-O3 solution improved pain and Boston Carpal Tunnel Questionnaire score after eight weeks (p<0.001); however, the change was nonsignificant compared to the corticosteroid group (p>0.05). Sensory nerve and compound muscle action potential latencies were not significantly changed eight weeks after O2-O3 injection (p>0.05), while both were significantly decreased in the steroid injection group (p<0.001). Volar bulging and median nerve cross-section surface area were not improved after O2-O3 injection, while the improvement was significant in the corticosteroid arm (p=0.02).

Conclusion

Symptoms in patients with mild to moderate CTS may be alleviated by local O2-O3 injection; however, electrodiagnostic and ultrasonographic indices may be unchanged. Corticosteroid local injection may alleviate patient symptoms along with electrodiagnostic and ultrasonographic parameters.

Retracted: Efficacy of Dexamethasone versus Dexmedetomidine Combined with Local Anaesthetics in Brachial Plexus Block: A Meta-Analysis and Systematic Review

[This retracts the article DOI: 10.1155/2022/7996754.].

The Comparison of Dexmedetomidine to Dexamethasone as Adjuvants to Bupivacaine in Ultrasound-Guided Infraclavicular Brachial Plexus Block in Upper Limb Surgeries

Background The clinical utility of adjuvants with local anesthesia produces an excellent nerve block with prolonged duration and faster onset. Brachial plexus block is widely used nowadays in patients undergoing upper limb surgery There are several approaches to achieve brachial plexus block such as interscalene, supraclavicular, infraclavicular, and axillary. The objective of this study is to compare the effectiveness of dexamethasone to dexmedetomidine as adjuvants to bupivacaine in patients undergoing ultrasound-guided infraclavicular brachial plexus (USG-ICBP) block. Methods A randomized, prospective, double-blind study was undertaken on the patients posted for upper limb surgeries under ultrasound-guided infraclavicular brachial plexus block. Sixty patients with the American Society of Anesthesiologists (ASA) classes I and II were randomly allocated into two groups. Group A received 25 mL of 0.5% bupivacaine and 1.5 mL (6 mg) of dexamethasone, and group B received 25 mL of 0.5% bupivacaine and 0.75 mL (75 mcg) of dexmedetomidine along with 0.75 mL of 0.9% normal saline (NS). Student's t test or Mann-Whitney test and chi-square test were used for statistical analysis. Results The onset of sensory block was significantly faster in the patients in group B as compared to the patients in group A. In terms of the duration of the block, sensory and motor blocks were maintained for a significantly longer duration in the group A patients as compared to those in group B. Moreover, the duration of postoperative analgesia was significantly longer-lasting in the group A patients. In terms of adverse effects, procedure-related complications such as the failure of the block and inadequate block were comparable across the groups. However, drug-related adverse effects were significantly more common in group B. Conclusion As compared to 75 mcg of dexmedetomidine, the addition of 6 mg of dexamethasone as adjuvant to 25 mL of 0.5% bupivacaine resulted in significantly longer-lasting sensory and motor blocks, postoperative analgesia, and a delayed time for first rescue analgesia without increasing undue adverse effects. Dexmedetomidine use is associated with more sedation as compared to dexamethasone.