A New Step Toward Evidence of In Vivo Perineural Dexamethasone Safety

Marty, Philippe; Bennis, Mehdi; Legaillard, Benjamin; Cavaignac, Étienne; Ferré, Fabrice; Lebon, J; Brouchet, A.; Minville, Vincent

doi:10.1097/aap.0000000000000392

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…However, despite its increasing popularity,1–21 PN remains an off-label adjuvant. Theoretical concerns of neurotoxicity may persist, as no human study has been carried out to analyze neural injury caused by LA combined with PN dexamethasone 29. Therefore, during the inception phase of our trial, we reasoned that if 2 mg of PN dexamethasone can be equivalent to 5 mg or 8 mg, it would provide clinicians with a non-negligible 60%–75% decrease in commonly used doses of PN dexamethasone.…”

Section: Discussionmentioning

confidence: 99%

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

Bravo

Layera

Fernández

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesThis multicenter, randomized trial compared 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular brachial plexus block. Our research hypothesis was that all three doses of dexamethasone would result in equivalent durations of motor block (equivalence margin=3.0 hours).MethodsThree hundred and sixty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block were randomly allocated to receive 2, 5, or 8 mg of preservative-free perineural dexamethasone. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) was identical in all subjects. Patients and operators were blinded to the dose of dexamethasone. During the performance of the block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia. The main outcome variable was the duration of motor block.ResultsNo intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain complications), onset time, success rate, and surgical anesthesia. Furthermore, all three doses of dexamethasone provided similar durations of motor block (14.9–16.1 hours) and sensory block. Although 5 mg provided a longer analgesic duration than 2 mg, the difference (2.7 hours) fell within our pre-established equivalence margin (3.0 hours).Conclusions2, 5, and 8 mg of dexamethasone provide clinically equivalent sensorimotor and analgesic durations for ultrasound-guided infraclavicular block. Further trials are required to compare low (ie, 2 mg) and ultra-low (eg, 0.5–1 mg) doses of perineural dexamethasone for brachial plexus blocks.Trial registration numberTCTR20150624001.

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Section: Discussionmentioning

confidence: 99%

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

Bravo

Layera

Fernández

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…Recent studies do not support any evidence of neural toxicity of dexamethasone when administered perineurally. 26,27 However, these experimental results need to be confirmed before extending the routine use of perineural administration to humans.…”

Section: Discussionmentioning

confidence: 99%

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

Marty

Rontes

Chassery

et al. 2018

Regional Anesthesia and Pain Medicine

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“…The good news regarding dexamethasone for regional anaesthesia is that there seems to be no evidence for harm. The drug seems to be relatively inert regarding toxic effects on nerves and other tissues (when administered perineurally), haemodynamic and sedation effects and blood glucose levels. There is only one investigation where a possible influence of locally administered dexamethasone on neuronal blood flow is discussed , but the effect seems unlikely to be clinically‐relevant.…”

Section: Systematic Reviewsmentioning

confidence: 99%

Dexamethasone in regional anaesthesia: travelling up a blind alley?

Marhofer

Hopkins

2019

Anaesthesia

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A New Step Toward Evidence of In Vivo Perineural Dexamethasone Safety

Abstract: A combination of ropivacaine and perineural dexamethasone allows longer sensory block duration compared with ropivacaine alone or ropivacaine and systemic dexamethasone, without increased neural toxicity.

Cited by 17 publications

References 22 publications

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

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

Dexamethasone in regional anaesthesia: travelling up a blind alley?

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