1. Low-volume local anesthetic with intravenous dexamethasone reduced the incidence of diaphragmatic paresis and provided equivalent analgesic duration compared to the conventional volume of local anesthetic in arthroscopic shoulder surgery

Evidence Rating Level: 1 (Excellent)

Severe postoperative pain is common in patients undergoing arthroscopic shoulder surgery. Therefore, appropriate analgesia and rehabilitation are key for recovery. Interscalene brachial plexus block provides effective analgesia after arthroscopic shoulder surgery but carries a high risk of diaphragmatic paresis. Similarly, a superior trunk block carries a risk of diaphragmatic paresis as well. To avoid this complication, a low-volume local anesthetic can be used. In conjunction, intravenous dexamethasone has been proposed to prolong the duration of the peripheral nerve block. This study aimed to see if intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining analgesic duration compared to normal local anesthetic without dexamethasone. The primary outcomes were the analgesic duration and the incidence of diaphragmatic paresis. The secondary outcomes included the pain score, total opioid consumption, pulmonary function test results, patient satisfaction with pain control, blood glucose level, and incidence of postoperative nausea and vomiting.  The duration of analgesia was higher in the dexamethasone group with a mean of 12.4 ± 6.8 hours and 11.2 ± 4.6 hours in the control group (p < 0.001). The incidence of diaphragmatic paresis was also significantly lower in the treatment group (p < 0.001). No significant difference in postoperative pain between the two groups were noted during the first 24 hours postoperatively. Total opioid consumption was lower in the dexamethasone group. No significant changes were seen in the pulmonary function tests, patient satisfaction, blood glucose, postoperative nausea, and vomiting. No patients developed any block-related complications (hematoma, local anesthetic systemic toxicity, or neurologic injury). Therefore, low-volume local anesthetic with intravenous dexamethasone reduced the incidence of diaphragmatic paresis and provided equivalent analgesic duration compared to the conventional volume of local anesthetic in arthroscopic shoulder surgery. 

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