A randomised controlled trial of perineural vs intravenous dexamethasone for foot surgery

Abstract

SummaryWe used 20 ml ropivacaine 0.75% for ankle blocks before foot surgery in 90 participants who we allocated in equal numbers to: perineural dexamethasone 8 mg and intravenous saline 0.9%; perineural saline 0.9% and intravenous dexamethasone 8 mg; or perineural and intravenous saline 0.9%.

Perineural Versus Systemic Dexamethasone in Front-Foot Surgery Under Ankle Block

“…16 Previous randomized double-blind studies reported equivalence of perineural and systemic routes using high systemic dexamethasone dose (>8 mg) when added to long-acting LAs. 17,18 Other previous randomized double-blind studies reported superiority of perineural route when using low systemic dexamethasone dose (<8 mg). 19,20 In this controversial topic, evidence based on well-designed studies should be considered.…”

Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks

“…5,6,15,19 Sensory block duration was also only reported by 5 studies, with the rest solely reporting the duration of analgesia. 5,8,[15][16][17] For these studies, perineural dexamethasone prolonged sensory block by 2.28 hours (95% CI, 0.38-4.17; P = 0.019) compared with IV dexamethasone. In sensitivity analysis where we substituted data for postoperative analgesia (where data for sensory block were missing), the direction of effect was unchanged with 3.58 hours (95% CI, 1.75-5.41; P < 0.001) longer duration with perineural dexamethasone compared to IV dexamethasone.…”

“…1, PRISMA flow diagram). 5,6,8,[13][14][15][16][17][18][19][20] Notably, we excluded certain studies during our full-text review: 2 studies that compared IV/perineural clonidine and/or buprenorphine alongside dexamethasone, 21,22 one study where a continuous infusion was started prior to complete resolution of the sensory block, 23 one study where all patients received IV dexamethasone, 8 mg, 4 and finally one study where all patients received long-acting intrathecal narcotics. 24 …”

“…2). 5,6,8,11,[13][14][15][17][18][19] Three studies provided enough information to ascertain if the dexamethasone administered was preservative-free, and this was left undescribed by the rest. 5,6,16 One study published an erratum to their results and this corrected data were used in our metaanalysis.…”

Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery

“…29,30 It is not clear whether the effect of dexamethasone is primarily local or systemic. 31,32 It seems that IV dexamethasone is required in higher doses to produce the same prolongation of duration of nerve blocks. 33,34 The aim of this study was to assess the effect of dexamethasone on the duration of saphenous nerve block after major ankle surgery.…”