الفهرس 
Acknowledgement
Pharmacology of LevobupivacaineOnly 14 pages are availabe for public view
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Abstract
The present study was a prospective randomized clinical trial aimed to compare the effectiveness of perineural tramadol versus dexamethasone added to levobupivacaine in terms of onset and duration of sensory and motor block, duration of postoperative analgesia, patient satisfaction scoring, visual analog score (VAS) scoring, requirements of rescue analgesia, hemodynamics, and drug-related adverse effects in patient undergoing internal fixation and reduction for forearm fractures at Assiut University Hospital, Assiut, Egypt in the period from the 1st of April 2020 up to the end of December 2020.
The studied participants were randomized to two groups:
- Dexamethasone group: patient received 0.4 mL/kg of 0.5% levobupivacaine plus 8 mg of dexamethasone.
- Tramadol group: patient received 0.4 mL/kg of 0.5% levobupivacaine plus 1.5 mg/kg of 5% tramadol.
Both studied groups were comparable regarding to age, weight, height, sex, ASA, past medical history, duration of surgery with no significant difference between them, also the laboratory data show no significant difference between both studied groups. Additionally, the mean time (minutes) to both sensory and motor blockage show no significant difference between both studied groups
The pre-operative vital signs (heart rate, systolic & diastolic BP, and O2 saturation) were comparable among both studied groups with no significant difference between them.
The intraoperative hemodynamic profile was assessed at 6 time points (at the start of surgery, 15, 30, 45, 60, 75 minutes) and shows no significant difference between both studied groups.
Postoperative hemodynamic parameters, intraoperative adverse effects and complications show no significant differences between both studied groups.
The mixture of dexamethasone and levobupivacaine injected perineurally for supraclavicular brachial plexus block, under the guidance of ultrasound, hastens the onset of sensory block, motor block, decreased the postoperative VAS scoring, prolonged duration of analgesia, and decreased the number of rescue analgesia doses as compared to tramadol group.
Conclusion
In the present study, dexamethasone as an additive to levobupivacaine in patients undergoing upper limb surgery was superior to tramadol in increasing the duration of postoperative pain relief with lower postoperative pain scores, longer time for the first analgesic request, lower analgesic requirement, and less incidences of adverse effects. Consequently, dexamethasone can be used as an adjuvant to local anesthetics if tramadol is not accessible or contraindicated.