A Randomized Controlled Trial Studying the Role of Dexamethasone in Scalp Nerve Blocks for Supratentorial Craniotomy

Abstract

Addition of dexamethasone as an adjuvant to local anesthetics in scalp nerve blocks in the setting of perioperative steroid therapy does not appear to provide any additional benefit with respect to prolongation of the duration of the block.

Dexamethasone Use in Perioperative Neuroscience: Boon or Bane, or Both?

“…A randomized controlled trial of 90 patients receiving perioperative dexamethasone for cerebral edema found that dexamethasone (8 mg) added to a local anesthetic mixture (2% lidocaine and 0.2% ropivacaine with adrenaline 5 μg/mL) for perineural scalp block did not prolong block duration compared with placebo. 9 Despite the obvious benefits of dexamethasone, many controversies remain. Dexamethasone is a potent, longacting glucocorticoid with wide-ranging physiological actions, as well as several adverse effects, including insulin resistance, hyperglycemia, immunosuppression, and poor wound healing (Table 1).…”

“…The role of dexamethasone as an adjuvant in scalp block is also inconclusive. A randomized controlled trial of 90 patients receiving perioperative dexamethasone for cerebral edema found that dexamethasone (8 mg) added to a local anesthetic mixture (2% lidocaine and 0.2% ropivacaine with adrenaline 5 μg/mL) for perineural scalp block did not prolong block duration compared with placebo 9 …”

REDUCE trial: the effects of perineural dexamethasone on scalp nerve blocks for relief of postcraniotomy pain—a study protocol for a randomized controlled trial

“…Based on previous studies [19][20][21]43] and our clinical practice, the average duration of analgesia after supratentorial craniotomy was approximately 600 min with a standard deviation (SD) of 240 min for patients who received scalp nerve blocks with a local anesthetic alone (the control group). A difference of 60 min in average duration of analgesia is considered the minimally clinically significant difference.…”

Faculty Opinions recommendation of Regional anesthesia in neuroanesthesia practice.

“…Adjuvants like opioids, dexmedetomidine 12 , dexamethasone and magnesium sulphate 13 have been investigated by different investigators for their effect on the improvement of the quality and duration of the block with varying results. Meta-analysis of different randomised control studies (RCTs) have demonstrated a consistent reduction of pain severity 14 , which extends 6 hours after craniotomy 15 .…”