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

Abstract

Background Pain is common in the first 2 days after major craniotomy. Inadequate analgesia may lead to an increased risk of postoperative complications. Most pain following craniotomy arises from the pericranial muscles and soft tissues of the scalp. Scalp nerve blocks with local anesthesia seem to provide effective, safe, however, transient postoperative analgesia which does not seem to meet the requirements of craniotomy. Currently, peripheral dexamethasone has been observed to significantly prolong the duration of analgesia of nerve blocks (e.g., saphenous nerve block, adductor canal block, thoracic paravertebral block, brachial plexus nerve block). On the contrary, a study reported that perineural dexamethasone did not appear to prolong the analgesic time after supratentorial craniotomy. However, all patients in this study were given 24 mg of oral or intravenous dexamethasone regularly for at least 7 days during the perioperative period, which possibly masked the role of single local low doses of perineural dexamethasone. Therefore, the analgesic effect of single dexamethasone for scalp nerve blocks without the background of perioperative glucocorticoid deserves further clarification. Methods The REDUCE trial is a prospective, single-center, parallel-group randomized controlled trial involving a total of 156 adults scheduled for elective craniotomy with general anesthesia. Patients will be randomly divided among two groups: the control group (n = 78) will receive scalp nerve blocks with 0.5% bupivacaine, plus normal saline with epinephrine at 1:200,000; the DEX4mg group (n = 78) will receive scalp nerve blocks with 0.5% bupivacaine, plus 4 mg dexamethasone with epinephrine at 1:200,000. The primary outcome will be the duration of analgesia, defined as the time between the performance of the block and the first analgesic request. Discussion The REDUCE trial aims to further assess the analgesic effect of single dexamethasone as an adjuvant to scalp nerve blocks for relief of postcraniotomy pain without the background of perioperative glucocorticoid. Trial registration ClinicalTrials.govNCT04648358. Registered on November 30, 2020.

Regional Anesthesia Techniques in Modern Neuroanesthesia Practice: A Narrative Review of the Clinical Evidence

“…perineural dexamethasone in the context of peripheral nerve blockade. 37 The purported analgesic benefits of perineural dexamethasone will be further explored in an ongoing single-center RCT by Zhao et al, 38 in which 156 patients undergoing elective craniotomy without systemic steroid therapy will be randomized to receive scalp blocks with or without dexamethasone added to a 0.5% bupivacaine mixture.…”

Post-craniotomy Pain: An Update

“…72 The REDUCE trial to study the effects of dexamethasone as an additive to bupivacaine in scalp nerve block in patients without the background of perioperative glucocorticoid administration is underway. 73…”