Ultrasound-Guided Costoclavicular Brachial Plexus Block Using 0.5% Levobupivacaine Alone or With Dexamethasone as an Adjuvant for Upper Arm Surgical Anesthesia and Postoperative Analgesia: A Randomized Study

Regional anesthesia techniques, such as brachial plexus blocks, are widely used for upper limb surgeries. The costoclavicular approach is a relatively new technique that targets the brachial plexus cords in a compact arrangement. Adjuvants like dexamethasone have been shown to enhance the efficacy of local anesthetics in various regional blocks, but studies regarding their effect in costoclavicular brachial plexus block (CCB) with levobupivacaine are limited.

The objective of this study is to compare the efficacy of 0.5% levobupivacaine alone versus 0.5% levobupivacaine with dexamethasone as an adjuvant for CCB in patients undergoing upper limb surgeries.

This prospective, randomized, observer-blinded controlled trial included 60 patients undergoing elective upper limb surgeries. Patients were randomly allocated into two groups: Group A (n = 30) received 18 mL of 0.5% levobupivacaine with 2 mL of normal saline, while Group B (n = 30) received 0.5% levobupivacaine 18 mL with dexamethasone 2 mL (8mg). The primary outcome was the onset of sensory blockade. Secondary outcomes included the onset of motor blockade, duration of sensory and motor blockade, time to first analgesic request, and complications.

The dexamethasone group (Group B) demonstrated a significantly faster onset of both sensory (median 7 vs 9 minutes, p<0.01) and motor (median 11 vs 15.5 minutes, p<0.01) blockade. The duration of sensory (median 865 vs 496.5 minutes, p<0.01) and motor (median 840 vs 420 minutes, p<0.01) blockade was substantially prolonged in the dexamethasone group (Group B). Time to first analgesic request was significantly delayed in the dexamethasone group (median 847 vs 514 minutes, p<0.01). No significant complications were reported in either group.

The addition of dexamethasone to 0.5% levobupivacaine for CCB significantly enhances block efficacy, providing faster onset and prolonged duration, and extends postoperative analgesia compared to 0.5% levobupivacaine alone. This combination of levobupivacaine and dexamethasone can be a valuable option for optimizing regional anesthesia in upper limb surgeries.