Plasma Glucose Levels With Dexamethasone as Adjuvant to Interscalene Block

• Increased Blood Sugar after Dexamethasone added to local anesthetic for interscalene nerve block. [ Time Frame: 4 hours ] [ Designated as safety issue: No ]
  Normal fasting blood glucose is defined by investigators as less than 100mg/dL.(current literature suggests normal is 70-100 so investigators have chosen to utilize high normal.) Any increase greater than 10%(or 10mg/dL ) would be considered a response to the dexamethasone.
  
  

• Pain post-operative(immediately)- both at rest and with movement(VAS Scale) [ Time Frame: 4 hours ] [ Designated as safety issue: No ]
  Investigators will document patient pain in post-anesthesia care unit (both at rest and with movement)utilizing the VAS scale.
  
  
• Time until first narcotic usage post operatively [ Time Frame: 14 days ] [ Designated as safety issue: No ]
  Patients will be called for follow-up days 1, 2 and 14 and provided with a pain diary to document first narcotic usage.
  
  
• Block Quality and Duration(time until first motor return) [ Time Frame: 14 Days ] [ Designated as safety issue: No ]
  Patients will be called for follow up on days 1, 2 and 14 and provided with a pain diary to document the quality and duration of the motor block.
  
  
• Block Quality and Duration(time until first sensory return) [ Time Frame: 14 Days ] [ Designated as safety issue: No ]
  Patients will be called for follow up on days 1, 2 and 14 and provided with a pain diary to document the quality and duration of the sensory block.
  
  

Patients receiving regional anesthesia for orthopedic surgeries are provided with significant pain relief in the post-operative period. Dexamethasone as an adjuvant to local anesthetic has been shown to provide increased duration of block without adverse effects. Use of steroids as adjuvants are restricted to non-diabetics due to concern for increased plasma glucose from systemic absorption. The investigators hypothesize that there will be no difference(increase) from patient baseline(preoperative plasma glucose) in plasma glucose levels up to 4 hours post nerve block in patients who receive 8 mg of dexamethasone used as an adjuvant with local anesthetic to interscalene regional anesthesia. Research has demonstrated the safety and efficacy of dexamethasone as an adjuvant to local anesthetic in peripheral nerve block. Currently there are no studies which document any plasma glucose effects(or lack of effects) from dexamethasone used as an adjuvant to regional anesthesia. Currently dexamethasone is used clinically off label by anesthesiologists as an adjuvant in association with local anesthetic for nerve block anesthesia. Once studies are completed, the investigators hope to allow diabetics to also receive the prolongation of pain relief associated with the use of steroid as an adjuvant. In addition, the increased educational and pharmacological data gleamed from the data can potentially be utilized for future studies with dexamethasone utilized perineurally.