Comparative evaluation of bupivacaine 0.25% with dexamethasone 2mg versus bupivacaine 0.25% alone in greater auricular nerve block for postoperative analgesia in mastoid surgery

Background Pain severity after ear surgery is usually at its worst during the first few hours after surgery. The greater auricular nerve is the major sensory branch of the cervical plexus and is readily amenable to blockade as it lies superficially passing over the sternocleidomastoid muscle. Dexamethasone as an adjuvant is known to prolong analgesia. Aims and objectives To compare the efficacy of combination of bupivacaine 0.25% (9.5ml) with dexamethasone 2mg (0.5ml) versus bupivacaine 0.25% (9.5ml) with normal saline (0.5ml) in greater auricular nerve block for duration of analgesia and requirement of rescue analgesia postoperatively. Methodology Prospective double blind randomised controlled trial. Fifty patients aged 18-65 years; American Society of Anaesthesiologists physical status I / II posted for mastoid surgery were randomly allocated into two groups. Both groups received routine general anaesthesia. Intra operatively, analgesia was maintained with boluses of intravenous fentanyl 25 mu g each if required. At the end of surgery, just before extubation the nerve was identified using anatomical landmarks and blocked blindly with the drugs chosen depending on the group. The patients were extubated after complete reversal of neuromuscular blockade. Results Demographic data and type of surgery were similar in both the groups. There was a significant difference for duration of analgesia between the two groups (p<0.01). Conclusion Dexamethasone as an adjuvant to bupivacaine in greater auricular nerve block significantly increases the duration of analgesia and reduces the need for postoperative analgesics without any complications.