Dexamethasone as an Adjuvant to Femoral Nerve Block in Children and Adolescents Undergoing Knee Arthroscopy

Veneziano, Giorgio; Martin, David P.; Beltran, Ralph J; Barry, N’Diris; Tumin, Dmitry; Burrier, Candice; Klingele, Kevin E.; Bhalla, Tarun; Tobias, Joseph D.

doi:10.1097/aap.0000000000000739

Cited by 9 publications

(15 citation statements)

References 26 publications

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“…Intra-articular administration of local anesthetics can afford adequate analgesia, but this analgesia is short-term about 4 h. 31 Various adjuvant agents are added for the intraarticular injection of local anesthetics to prolong the analgesia duration. 11,32 Combining 50 mg of fentanyl with bupivacaine can prolong the period of analgesic effect to 9 h. 33 Another study comparing the 3 mg of morphine and 50 mg of fentanyl administered intra-articularly with a control group for knee arthroscopy reveals that intra-articular 50 mg fentanyl provides the best promotion to pain relief. 15 Our meta-analysis suggests that intra-articular fentanyl supplementation can substantially decrease the pain scores at 1, 2, and 8 h after knee arthroscopy but has no significant impact on pain scores at 4 h and the number of patients needing supplementary analgesia.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies

Wang

et al. 2020

J Orthop Surg (Hong Kong)

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Introduction: The efficacy of intra-articular fentanyl supplementation for pain control after knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intra-articular fentanyl supplementation for pain intensity after arthroscopic knee surgery. Methods: We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through May 2019 for randomized controlled trials (RCTs) assessing the efficacy and safety of intra-articular fentanyl supplementation for arthroscopic knee surgery. This meta-analysis is performed using the random-effects model. Results: Four RCTs are included in the meta-analysis. Overall, compared with control group after knee arthroscopy, intra-articular fentanyl supplementation is associated with reduced pain scores at 1 h (standard mean difference (Std MD) = −3.50; 95% confidence interval (CI) = −5.68 to −1.32; p = 0.002), 2 h (Std MD = −4.73; 95% CI = −8.75 to −0.71; p = 0.02), and 8 h (Std MD = −5.02; 95% CI = −9.73 to −0.30; p = 0.04) but shows no substantial impact on pain scores at 4 h (Std MD = −3.94; 95% CI = −7.93 to 0.05; p = 0.05) or the supplementary analgesia (risk ratio = 0.56; 95% CI = 0.09–3.59; p = 0.54). Conclusions: Intra-articular fentanyl supplementation does benefit in pain control after knee arthroscopy.

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Section: Discussionmentioning

confidence: 99%

The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies

Wang

et al. 2020

J Orthop Surg (Hong Kong)

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“…In this study, 0.2% RP will be administered, and this concentration is generally recommended by the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee 29. In children, 0.025% dexamethasone can be applied locally, which is the most frequently used concentration in clinical practice and provides effective postoperative analgesia during otolaryngology and orthopaedic surgery 37 44. The potency of dexamethasone, however, is five times stronger than that of MP 45.…”

Section: Discussionmentioning

confidence: 99%

Pre-emptive scalp infiltration with ropivacaine plus methylprednisolone versus ropivacaine alone for relief of postoperative pain after craniotomy in children (RP/MP vs RP): a study protocol for a randomised controlled trial

Zhao

Jia

et al. 2019

BMJ Open

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IntroductionPre-emptive scalp infiltration with local anaesthetics is the simplest and most effective method to prevent postoperative incisional pain. However, local infiltration of an anaesthetic only provides relatively short-term pain relief. Methylprednisolone (MP) treatment, administered as an adjuvant at the wound site, has been shown to provide satisfactory pain management after lumbar laminectomy. However, there is no evidence regarding the efficacy of MP infiltration for the relief of postoperative pain after craniotomy. Currently, postoperative pain after craniotomy in children is undertreated. Therefore, we aim to investigate whether pre-emptive scalp infiltration with ropivacaine (RP) plus MP is superior to RP alone to improve postoperative pain after craniotomy in children.Methods and analysisThe RP/MP versus RP trial is a prospective, single-centre, randomised, parallel-group study of 100 children aged 8–18 years undergoing intracranial surgery. Participants will be randomly allocated to receive pre-emptive scalp infiltration with either RP plus MP or RP alone. The primary outcome will be the cumulative fentanyl dose administered by patient-controlled intravenous analgesia within 24 hours postoperatively. The secondary outcomes will include postoperative Numerical Rating Scale scores, pain control satisfaction scores, length of stay and adverse events. Data will be analysed by the intention-to-treat principle.Ethical approval and disseminationThe study protocol has been approved by the Institutional Review Board of Beijing Tiantan Hospital Affiliated to Capital Medical University (Approval Number: KY 2018-066-02). The results will be disseminated in international academic meetings and published in peer-reviewed journals.Trial registration numberNCT03636165; Pre-results.

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“…Finally, 4 RCTs that meet our inclusion criteria are included in the meta-analysis. [18][19][20]25] The baseline characteristics of the 4 eligible RCTs in the metaanalysis are summarized in Table 1. The 4 studies were published between 2016 and 2018, and sample sizes ranged from 40 to 78 with a total of 228.…”

Section: Literature Search Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Recently, several studies on the topic have been published, and the results have been conflicting. [18][19][20] With accumulating evidence, we therefore perform a systematic review and meta-analysis of RCTs to compare the efficacy of dexamethasone supplementation vs placebo for knee arthroscopy.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of dexamethasone on pain management for knee arthroscopy

Peng

Yuan

et al. 2020

Medicine

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Introduction:The impact of dexamethasone on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexamethasone for knee arthroscopy.Methods: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of dexamethasone on pain intensity for patients with dental implant. This meta-analysis is performed using the random-effect model.Results: Four RCTs involving 228 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, dexamethasone supplementation has no notable effect on pain scores at 4 to 6 hours (Std. MD = 0.99; 95% CI = À2.97 to 4.95; P = .62), but exerts significantly favorable promotion to pain scores at 12 hours (Std. MD = À1.06; 95% CI = À1.43 to À0.69; P < .00001), duration of block (Std. MD = 1.87; 95% CI = 0.65 to 3.10; P = .003), time to first analgesic requirement (Std. MD = 0.90; 95% CI = 0.51 to 1.29; P < .00001), analgesic consumption (Std. MD = -1.62; 95% CI = À2.31 to À0.93; P < .00001), and patient satisfaction (Std. MD = 1.15; 95% CI = 0.73 to 1.58; P < .00001).Conclusions: Dexamethasone supplementation has importantly positive influence on pain control for knee arthroscopy.

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Dexamethasone as an Adjuvant to Femoral Nerve Block in Children and Adolescents Undergoing Knee Arthroscopy

Abstract: This study was registered at ClinicalTrials.gov, identifier NCT01971645.

Cited by 9 publications

References 26 publications

The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies

The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies

Pre-emptive scalp infiltration with ropivacaine plus methylprednisolone versus ropivacaine alone for relief of postoperative pain after craniotomy in children (RP/MP vs RP): a study protocol for a randomised controlled trial

The efficacy of dexamethasone on pain management for knee arthroscopy

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