Dexamethasone as an adjuvant to peripheral nerve block

Pehora, Carolyne; Pearson, Annabel; Kaushal, Alka; Crawford, Mark W.; Johnston, Bradley C.

doi:10.1002/14651858.cd011770

Cited by 40 publications

(57 citation statements)

References 50 publications

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“…Additionally, 63% of studies did not mention whether any antiemetic was given to treat nausea and/or vomiting. Hence there is potential for confounding as corticosteroids such as intravenous dexamethasone have been demonstrated to prolong analgesic duration and sensory blockade in some studies (Heesen et al., 2018; Pehora, Pearson, Kaushal, Crawford, & Johnston, 2017; Shalu & Ghodki, 2017). Funding sources were also not declared in 58% of the studies and will introduce further biases especially if they were industry sponsored.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

Paramasivan

López-Olivo

Foong

et al. 2020

European Journal of Pain

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Background and Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) was undertaken to evaluate the effect of intrathecal dexmedetomidine (DEX) on the duration of postoperative analgesia, postoperative pain scores and incidences of adverse effects. Databases and Data Treatment: Database search was performed from inception until January 2019. All RCTs analysing acute postoperative pain characteristics after intrathecal DEX administration in adults undergoing spinal anaesthesia for elective surgery were included. The primary outcome was postoperative analgesic duration, defined as the time to first analgesic request. The secondary outcomes included pain scores at 6, 12 and 24 postoperative hours and rates of hypotension, bradycardia, shivering and postoperative nausea and vomiting. Results: Twenty-four studies comprising a total of 1,460 patients were included. Postoperative analgesic duration was prolonged with intrathecal DEX compared to placebo, with a pooled mean difference (MD) of 191.3 min (95% CI 168.8-213.8). Patients who received intrathecal DEX reported lower Visual Analogue Scale scores at 24 postoperative hours compared with those patients receiving placebo, with a MD (95% CI) of −1.05 (−1.89 to −0.20, p = 0.02). There were no differences in the incidence of adverse effects, except for a lower rate of postoperative shivering in the intrathecal DEX group (pooled relative risk 0.58, 95% CI 0.34-0.98, p = 0.04). Conclusions: Compared to placebo, intrathecal DEX prolonged postoperative analgesic duration, reduced 24-hr pain intensity and reduced the incidence of shivering without an increase in other adverse effects. Significance: The analgesic role of intrathecal DEX is promising due to its ability to significantly increase postoperative analgesic duration when compared with placebo. Its usage can be considered for patients undergoing surgeries with significant postoperative pain, particularly those intolerant of systemic analgesia. However, the optimal dose for various surgeries as well as its long-term neurological effects warrants further studies.

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Section: Discussionmentioning

confidence: 99%

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

Paramasivan

López-Olivo

Foong

et al. 2020

European Journal of Pain

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“…If dexamethasone is used, toxicity studies suggest limiting perineural dose to 1 to 2 mg 263 264. A recent Cochrane review concluded that current evidence is insufficient to determine the effectiveness of dexamethasone as an adjuvant for lower extremity regional anesthesia 265. As with epinephrine, the use of dexamethasone around diabetic peripheral nerves remains controversial.…”

Section: Adjuvant Selectionmentioning

confidence: 99%

Lower extremity regional anesthesia: essentials of our current understanding

Tran

Salinas

Benzon

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

140

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The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine’s ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

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“…Numerous meta‐analyses have evaluated perineural dexamethasone in mainly brachial plexus blockade, but also dental, peribulbar, sciatic nerve and transversus abdominis plane blocks [41, 42]. In a meta‐analysis of 29 trials, Albrecht et al.…”

Section: Novel Local Anaesthetic Adjunctsmentioning

confidence: 99%

Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review

2021

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Summary Moderate‐to‐severe postoperative pain persists for longer than the duration of single‐shot peripheral nerve blocks and hence continues to be a problem even with the routine use of regional anaesthesia techniques. The administration of local anaesthetic adjuncts, defined as the concomitant intravenous or perineural injection of one or more pharmacological agents, is an attractive and technically simple strategy to potentially extend the benefits of peripheral nerve blockade beyond the conventional maximum of 8–14 hours. Historical local anaesthetic adjuncts include perineural adrenaline that has been demonstrated to increase the mean duration of analgesia by as little as just over 1 hour. Of the novel local anaesthetic adjuncts, dexmedetomidine and dexamethasone have best demonstrated the capacity to considerably improve the duration of blocks. Perineural dexmedetomidine and dexamethasone increase the mean duration of analgesia by up to 6 hour and 8 hour, respectively, when combined with long‐acting local anaesthetics. The evidence for the safety of these local anaesthetic adjuncts continues to accumulate, although the findings of a neurotoxic effect with perineural dexmedetomidine during in‐vitro studies are conflicting. Neither perineural dexmedetomidine nor dexamethasone fulfils all the criteria of the ideal local anaesthetic adjunct. Dexmedetomidine is limited by side‐effects such as bradycardia, hypotension and sedation, and dexamethasone slightly increases glycaemia. In view of the concerns related to localised nerve and muscle injury and the lack of consistent evidence for the superiority of the perineural vs. systemic route of administration, we recommend the off‐label use of systemic dexamethasone as a local anaesthetic adjunct in a dose of 0.1–0.2 mg.kg−1 for all patients undergoing surgery associated with significant postoperative pain.

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Dexamethasone as an adjuvant to peripheral nerve block

Cited by 40 publications

References 50 publications

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

Lower extremity regional anesthesia: essentials of our current understanding

Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review

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