Dexamethasone as a ropivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: A randomized, double-blinded clinical trial

Ultrasound‐guided adductor canal block after arthroscopic anterior cruciate ligament reconstruction: Effect of adding dexamethasone to bupivacaine, a randomized controlled trial

“…Sakae et al. () found that perineural dexamethasone was associated with a more prolonged duration of analgesia than intravenous as an adjuvant to brachial plexus block.…”

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

“…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. Future studies investigating the dosage response of systemic and perineural dexamethasone are warranted.…”

Reply to Dr Pan

“…[2][3][4] In their editorial letter that is largely concordant with our original analysis, Pan et al 1 are statistically correct to conclude that "perineural dexamethasone [can] induce longer duration of [a] nerve block and provide better postoperative analgesia" compared with intravenous administration. However, in our opinion, the data do not support that the magnitude of effects for either of these outcomes is clinically meaningful.…”

“…2 In their editorial letter, they update the main outcomes of our meta-analysis with the newly published trial by Sakae et al 1,3 They conclude that "Perineural dexamethasone can induce longer duration of [a] nerve block and provide better postoperative analgesia than intravenous dexamethasone in patients receiving peripheral nerve blocks." 1 Although their findings are generally consistent with our original conclusions, we would like to consider some limitations in their analysis and emphasize that the current evidence base is not strongly in favor of the widespread adoption of offlabel perineural dexamethasone.…”

“…1). 3 Although only the latter value achieves statistical significance (Bonferroni corrected α threshold of 0.0125), neither value meets the 2-point threshold (on a 10-point scale) that most clinicians would consider clinically meaningful for acute pain. 5 Furthermore, other important limitations include the fact that only 3 studies reported pain scores at 12 hours and high statistical heterogeneity for the 24-hour data (I 2 = 79.6%).…”