Perineural Dexamethasone to Improve Postoperative Analgesia with Peripheral Nerve Blocks: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI) of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682) minutes, and motor block duration, 500 (154 to 846) minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, −8.5 (−12.3 to −4.6) mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug.

Effect of dexamethasone as an adjuvant with bupivacaine in ultrasound guided single shot supraclavicular brachial plexus block in upper extremity surgeries- a prospective randomized study

“…2 Different drugs have been used as adjuvant to achieve quick, dense and prolonged block. 7 Various adjuvants such as tramadol, neostigmine, clonidine, dexamethasone, etc., were tried to enhance the duration of analgesia in supraclavicular brachial plexus block. [8][9][10] They improve analgesia, reduces systemic side effects and reduce total dose of local anaesthetic required.…”

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

“…The mechanism of action of DXM on the peripheral nerves during perineural injection is unknown [13][14][15]. The scattered experimental data do not enable their combination into an integral theory explaining this phenomenon [20][21][22][23][24].…”

“…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.…”

“…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. Negative results were obtained by Knezevic et al [17], Fredrickson et al [18] and YaDeau et al [19].…”

Effect of Adding Dexamethasone to Bupivacaine on Transversus Abdominis Plane Block [Transversus Abdominis Plane Bloga Eklenen Deksametazonun Etkisi]

“…Ancak hangi ajanın seçileği ve veriliş yolu tartışmalıdır [8]. Bupivakaine adjuvan olarak deksametazon katıldığında bupivakainin etki süresinin uzadığı ve analjezi kalitesinin arttığı gösterilmiştir [8][9][10][11]. Sistemik verilen deksametazonun analjezik, antiemetik etkinliği rapor edilmiştir [12,13].…”