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Longer duration of block analgesia seen with steroids added to local anesthetic
Results from this study demonstrated the addition of steroids to the local anesthetic during brachial plexus blockade led to a statistically longer duration of block analgesia than blocks performed without steroids.
Researchers performed a prospective comparative study of 910 patients who underwent interscalene brachial plexus blocks prior to shoulder surgery. There were 574 patients who were randomly assigned to receive an injected local anesthetic with the addition of the steroid triamcinolone acetonide, while 336 patients received the injection without steroids. Investigators had patients keep logs within the first 2 days postoperatively and telephone interviews were conducted 36 hours postoperatively to record the block duration, side effects and complications. After 10 days postoperatively, patients had an office follow-up.
Results showed patients who received steroids and patients who did not had an overall success rate of 98% and 97%, respectively. Investigators noted side effects, persistent neurological complications, as well as adverse events, were not significantly different between groups. A statistically longer duration of block analgesia was seen in patients who received steroids. ‒ by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
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This well-written paper presents a compelling experience in which the authors nearly doubled the analgesic effect of an interscalene block by adding 25 mg of triamcinolone acetonide to the bupivacaine. There was no difference in the observed complications between patients who received an interscalene block with steroid and those who received a block without steroid.
While convincing, the study presented, unfortunately, lacks sufficient rigor to be conclusive. This was not a randomized controlled study and it is unclear how the authors decided which patients would receive steroids. It is also unfortunate that the clinicians evaluating the patients’ postoperative pain level were not blinded to which patients received steroids. Their results are consistent with the findings of other authors reporting on regional anesthesia with and without supplemental steroid. As such, further study with greater control over patient selection and examiner bias would be of great interest.