Dexamethasone as an adjuvant to peripheral nerve block

Abstract

Low- to moderate-quality evidence suggests that when used as an adjuvant to peripheral nerve block in upper limb surgery, both perineural and intravenous dexamethasone may prolong duration of sensory block and are effective in reducing postoperative pain intensity and opioid consumption. There is not enough evidence to determine the effectiveness of dexamethasone as an adjuvant to peripheral nerve block in lower limb surgeries and there is no evidence in children. The results of our review may not apply to participants at risk of dexamethasone-related adverse events for whom clinical trials would probably be unsafe.There is not enough evidence to determine the effectiveness of dexamethasone as an adjuvant to peripheral nerve block in lower limb surgeries and there is no evidence in children. The results of our review may not be apply to participants who at risk of dexamethasone-related adverse events for whom clinical trials would probably be unsafe. The nine ongoing trials registered at ClinicalTrials.gov may change the results of this review.

Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series

“…17,18 At the same time, given the need for relatively large injectate volumes to achieve spread, we employed the maximum recommended dose of bupivacaine/ropivacaine in the initial bolus to avoid excessively low local anesthetic concentrations. While the ability of dexamethasone and dexmedetomidine to augment analgesia in ESP blocks is currently unsubstantiated, we chose to add them to the local anesthetic mixture based on data from peripheral nerve blockade [19][20][21] and the principle that opioid sparing is best achieved by using as many multimodal analgesic strategies as possible 2 rather than relying on a single ''silver bullet''.…”

Effect of intravenous dexamethasone on postoperative pain after spinal anaesthesia – a systematic review with meta‐analysis and trial sequential analysis

“…The added value of dexamethasone is based on the reduction in the side‐effects of opioids such as nausea and vomiting and on its anti‐inflammatory and anti‐nociceptive properties . It has also been shown that dexamethasone added intravenously or perineurally to peripheral nerve blocks of the upper limb can reduce pain severity and opioid consumption . Additionally, dexamethasone has strong anti‐emetic properties in the first 24 h after neuraxial blocks with long‐acting opioids .…”

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

“…Some reports of ESPB with dexamethasone added to the injectant stand out, eg, dexamethasone was reported to increase analgesia time significantly with no requirement for analgesics in the first 12 hours, with a numeric rating scale (NRS) scores <3 in the first 24 hours. 39,40 Literature review for bilateral ESPB PubMed and Google Scholar were searched on February 10, 2019 using the terms "erector spinae block" and "erector spinae plane block". Only English-language articles were reviewed.…”