Reduction in sodium content of local anesthetics for peripheral nerve blocks: A comparative evaluation of saline with 5% dextrose-A randomized controlled double-blind study

Shalini Dhir*, Luminita Tureanu, Amir Bouzari, Amna Masood, Mario Francispragasam, Sugantha Ganapathy

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background: Commercially available local anesthetic drugs when diluted with normal saline have high sodium content. High perineural sodium concentration has been implicated in antagonizing the analgesic effects of local anesthetics by preventing and/or delaying neural blockade. Five percent dextrose is not known to cause any short- or long-term injury when injected around neural tissue. In this study, we prospectively compared and evaluated block characteristics when local anesthetic drug was diluted with these 2 different agents. Methods: Patients scheduled for upper limb surgery were randomly assigned to receive axillary brachial plexus block with 0.5% ropivacaine (1% diluted with either 5% dextrose or normal saline). Motor and sensory block were tested every 5 minutes for 30 minutes. Postoperatively, a telephone interview was conducted after 24 hours and 7 days along with surgical follow-up at days 3, 10, and/or 14 to 28 days to document side effects, patient satisfaction, and time for block resolution. Any nerve deficits were followed until resolution. The primary outcome was time to onset of sensory nerve block. Results: Five hundred fifty patients were recruited for this study. The mean time to complete sensory block was 18.3 ± 6.1 minutes in the dextrose group and 22.5 ± 6.4 minutes in the saline group (P < 0.001, 95% confidence interval for mean difference 3.0-5.4 minutes). There were 5 patients with clinical nerve deficits (no statistical difference between groups). Conclusions: Dilution with 5% dextrose provides earlier onset of axillary brachial plexus block with ropivacaine.

Original languageEnglish (US)
Pages (from-to)1359-1364
Number of pages6
JournalAnesthesia and analgesia
Volume114
Issue number6
DOIs
Publication statusPublished - Jun 1 2012

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ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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