Interscalene Blocks with Decadron. My data.

[excalibur]

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I have been using PF decadron with my blocks for the last couple of months now, and these are the results I have gotten. The time listed is the time until the first sensation of pain after the block. I used 4 mg of decadron in nondiabetics and 2 mg of decadron in diabetic pts. This corresponds to what I read here on SDN mainly from BladeMDA and the articles he posted. Mind you that my institution does not put out the numbers of shoulder arthroscopies that others may be used to so the list may seem short. As you can see the duration of analgesia reflects exactly the numbers BladeMDA has been referencing. All blocks are USG with PNS attached as well. Here you go,


Interscalene block
Bupi 0.5% (30 mL) + 4 mg Decadron
1. 27 hrs
2. 28.5 hrs
3. 26 hrs
4. (2 mg) slight pain at 33 hrs but still motor block. 41.5 hrs complete resolution
5. 26 hrs
6. 26.5 hrs
7. (2 mg). 30.5 hrs
8. (2 mg) 29 hrs
9. (2 mg). 24 hrs
10. 27 hrs
11. 28 hrs

**Avg duration 27.77 hrs**

Pt number 4 was interesting in that I did an ISB on his other shoulder for another arthroscopy about 2 months prior to this visit. At that time i was using ropivacaine with no decadron or additives. He is a diabetic. He reported 14 hrs of analgesia with the ropivacaine block. He stated it was wonderful until it wore off at 10 pm on POD 0 and that night was miserable. He was OK with a prolonged block. On f/u he was much more pleased with the duration of the bupivacaine + decadron combo.

Here are some other blocks...

FEM-SCI
Bupi 0.5% + 2 mg Decadron 20ml
Bupi 0.5% + 2 mg Decadron 25ml
1. 42 hrs

Sci-saph
22 ml Bupi 0.5% and 8 ml saph
+ 4 mg
1. 28 hrs

Axillary
22ml Bupi 0.5% and 8 ml for MC nerve
1. (2 mg) 29 hrs

***All patients very satisfied. No complications to report.

 

[Oggg]

Thanks for sharing!! Those are great Numbers! I'm still waiting to get pf dexamethasone.

What is fem-saph?

 

[excalibur]

Thanks for sharing!! Those are great Numbers! I'm still waiting to get pf dexamethasone.

What is fem-saph?

Sorry, that's supposed to be sciatic-saph. Sciatic plus Saphenous nerve block

 

[BLADEMDA]

Thanks for posting your data. We pretty much Agree on the average duration of 0.5 percent Bup with decadron being around 26-27 hrs.

I'm getting that type of duration with lower volumes. Why not try 20 mls for some of your blocks and see if your duration is still 27 hours. I've been using 20 mls of 0.5 percent Bup with decadron for Femoral, Sciatic, Popliteal, Interscalene, Lumbar Plexus, etc with excellent results.

For the infraclavicular and supraclavicular blocks I'm still using 25 mls of local based on the published data; that said, if duration wasn't a concern then 20 mls placed under u/s should suffice.

 

[BLADEMDA]

The blocks which seem most prolonged for post op analgesia with decadron are the LPB/PCB and the Subcostal/standard TAP. I couldn't imagine doing these single shot blocks without the decadron.

 

[excalibur]

I simply used 30 because the vial is 30 mL and I am not close to toxicity. I am more curious to see if I get the same 26-27 hr duration with 2 mg in everybody.

 

[BLADEMDA]

I simply used 30 because the vial is 30 mL and I am not close to toxicity. I am more curious to see if I get the same 26-27 hr duration with 2 mg in everybody.

I bet the minimal dose is 2 mg. Even so on non diabetics I'm sticking with 4 mg of decadron. I wouldn't want even one patient to get a shorter block over 2 mg of decadron.

I've got no issues with 30 mls of local but since I block many older, frail patients it is important to stay below toxic doses especially when performing 2 nerve blocks on the same patient. Hence, it is nice to know that duration is still maintained at 26-27 hours even with 20 mls of 0.5 percent Bup.

 

[sevoflurane]

I simply used 30 because the vial is 30 mL and I am not close to toxicity. I am more curious to see if I get the same 26-27 hr duration with 2 mg in everybody.

Thanks for your report. 👍

Can you comment on the duration of motor block for interscalenes with 2mg of decadron (30mls of .5% marcaine)... if that data is available to you. Thanks and good work.

 

[excalibur]

Thanks for your report. 👍

Can you comment on the duration of motor block for interscalenes with 2mg of decadron (30mls of .5% marcaine)... if that data is available to you. Thanks and good work.

Regardless of whether I used 2 or 4 mg, most patients I followed up with reported motor block beginning to resolve approximately 2-4 hrs prior to first onset of pain.

The report would be something like "I couldn't feel anything or move my arm all through the night. I first started noticing tingling and movement in my hand around 7 am, and I could tell the block was wearing off. At around 10 am is when I could start feeling pain in my shoulder. By 11 am I could move my whole arm". The report of pain intensity upon resolution of block would vary, but it would still be significant. Usually they would report between 6-8/10. Most would say though that post 24 hrs pain is mangeable as long as they are not moving the shoulder. Up until that point they all would state pain was a zero. Zero out of 10 pain for 27 hrs sounds good to me!

 

[Oggg]

I think that suggests decadron prolongs the motor block?

 

[BLADEMDA]

I think that suggests decadron prolongs the motor block?

decadron prolongs the motor block. If you want to avoid a prolonged motor block then use Ropivacaine with decadron. You give up a few hours of analgesia but the motor block is significantly less than with Bupivacaine.