A systematic review and meta‐analysis of perineural dexamethasone for peripheral nerve blocks

Abstract

SummaryWe systematically reviewed the safety and efficacy of perineural dexamethasone as an adjunct for peripheral nerve blockade in 29 controlled trials of 1695 participants. We grouped trials by the duration of local anaesthetic action (short-or medium-vs long-term). Dexamethasone increased the mean (95% CI) duration of analgesia by 233 (172-295) min when injected with short-or medium-term action local anaesthetics and by 488 (419-557) min when injected with long-term action local anaesthetics, p < 0.00001 for both. However, these results should be interpreted with caution due to the extreme heterogeneity of results, with I 2 exceeding 90% for both analyses. Meta-regression did not show an interaction between dose of perineural dexamethasone (4-10 mg) and duration of analgesia (r 2 = 0.02, p = 0.54). There were no differences between 4 and 8 mg dexamethasone on subgroup analysis.

Analysis of efficacy of adding dexamethasone to ropivacaine in oral surgery

“…alveolares superiors posteriores) i deksametazona u oralnoj hirurgiji, kao i da smo u studiji upotrebili manje doze ove kombinacije od 4 ml 0,75% anestetika i 1 ml/4 mg deksametazona, nego one koje su navedene u literaturi, naši rezultati pokazuju da je ova kombinacija jednako uspešna za postizanje perioperativne i postoperativne anestezije kao i u drugim hirurškim granama [38][39] .…”

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

“…Albrecht et al 121 en un análisis realizado en el 2015 sobre el efecto PN de la dexametasona, en el que revisan 29 estudios prospectivos aleatorizados, que incluyen bloqueos del miembro superior, ciático, tobillo, peribulbar, transverso del abdomen y de la boca, afirman que la dexametasona prolonga en 488 minutos el efecto de los AL de larga duración y en 233 minutos el efecto analgésico de los AL de corta duración.…”

“…Sin embargo, recientes estudios 25,121 sugieren que dosis de 4 mg de dexametasona son igual de efectivas que dosis mayores (8-10 mg), correspondiendo estos hallazgos a estudios realizados en cirugía del miembro superior con bloqueos del nervio braquial y generalmente en un tipo de cirugías de menor poder álgico que la cirugía de PTR.…”

Perineural versus Intravenous Dexamethasone for Prolongation of Multiple Nerve Blocks for Pain Relief after Total Knee Arthroplasty

“…DXM was evaluated and appear to be an effective agent for prolonging the duration of PNB in preclinical [23,24], and clinical investigations [13-19, 25, 26]. Most of the previous studies were focused on clarifying the effects of DXM as a local anesthetic adjuvant for brachial plexus block [14,16], but even after a systemic review and meta-analysis the authors concluded that "Perineural administration of dexamethasone with LA prolongs brachial plexus block effects with no observed adverse events. The effects of systemic administration of dexamethasone on brachial plexus block must be investigated" [14].…”

“…This has led to the search for various additives to the LA solution following a perineural injection [13]. A systemic review with meta-analysis summarized the data of the effectivity and safety of perineural DXM, which is used as an adjuvant to LA for prolongation of the PNB [14][15][16]. A significant improvement and prolongation of the post-op analgesia was demonstrated [14,15] without difference between 4 mg and 8 mg of perineural DXM use.…”