Effect of dexamethasone on motor brachial plexus block with bupivacaine and with bupivacaine-loaded microspheres in a sheep model
Background and objective: It has been suggested that dexamethasone potentiates the sensory block produced by bupivacaine when both drugs are loaded in microspheres. The aim of the study was to evaluate the effect of dexamethasone on the brachial plexus block obtained with plain bupivacaine and bupivacaine-loaded microspheres.
Methods: Dexamethasone alone (Group 5) or added to plain bupivacaine (75 mg) with (Groups 3 and 4) and without pH correction (Group 2) was compared with plain bupivacaine (75 mg; Group 1). The effect of a small dose of dexamethasone (0.42 mg) was then evaluated on the brachial plexus block obtained with bupivacaine (750 mg) as bupivacaine-loaded microspheres (Group 6). Dexamethasone was added either in the suspending medium (Group 7) or incorporated with bupivacaine into microspheres (Group 8). The motor block was evaluated in a plexus brachial sheep model.
Results: Dexamethasone alone did not produce any motor block. When added to plain bupivacaine without pH correction, complete motor block could not be obtained. When the pH was corrected, addition of dexamethasone to plain bupivacaine seemed to delay the onset of motor block and did not prolong its duration, and it had no effect on the pharmacokinetics of bupivacaine. With bupivacaine-loaded microspheres, the duration of complete motor block was reduced when a small dose of dexamethasone was added in the suspending medium. However, the duration of motor block was significantly prolonged when dexamethasone was incorporated with bupivacaine into microspheres.
Conclusions: Despite the delayed onset of motor block, the incorporation of dexamethasone in bupivacaine-loaded microspheres dramatically increases the duration of action (700 ± 485–5160 ± 2136 min), which could be clinically relevant when such a drug-delivery system will be available.(Accepted July 2002)
Key Words: ANAESTHESIA, CONDUCTION, nerve block; ANAESTHETICS, LOCAL, bupivacaine; HORMONES, SYNTHETIC, dexamethasone, glucocorticoids, synthetic; INVESTIGATIVE TECHNIQUES, animal, models; SPINAL NERVES, brachial plexus.
c1 Correspondence to: Jean-Pierre Estebe, Service d'Anesthésie-Réanimation Chirurgicale 2, Hôpital Hôtel Dieu, 2 rue de l'Hôtel Dieu, F-35 000, Rennes, France. E-mail: firstname.lastname@example.org; Tel: +33 2 99 87 30 09; Fax: +33 2 99 87 34 13