Effect of intravenous dexamethasone on the duration of postoperative analgesia for popliteal sciatic nerve block: a randomized, double-blind, placebo-controlled study

Abstract

BackgroundIntravenous (IV) dexamethasone prolongs the duration of a peripheral nerve block; however, there is little available information about its optimal effective dose. This study aimed to evaluate the effects of three different doses of IV dexamethasone on the duration of postoperative analgesia to determine the optimal effective dose for a sciatic nerve block.MethodsPatients scheduled for foot and ankle surgery were randomly assigned to receive normal saline or IV dexamethasone (2.5 mg, 5 mg, or 10 mg). An ultrasound-guided popliteal sciatic nerve block was performed using 0.75% ropivacaine (20 ml) before general anesthesia. The duration of postoperative analgesia was the primary outcome, and pain scores, use of rescue analgesia, onset time, adverse effects, and patient satisfaction were assessed as secondary outcomes.ResultsCompared with the control group, the postoperative analgesic duration of the sciatic nerve block was prolonged in groups receiving IV dexamethasone 10 mg (P < 0.001), but not in the groups receiving IV dexamethasone 2.5 mg or 5 mg. The use of rescue analgesics was significantly different among the four groups 24 h postoperatively (P = 0.001) and similar thereafter. However, pain scores were not significantly different among the four groups 24 h postoperatively. There were no statistically significant differences in the other secondary outcomes among the four groups.ConclusionsThis study demonstrated that compared to the controls, only IV dexamethasone 10 mg increased the duration of postoperative analgesia following a sciatic nerve block for foot and ankle surgery without the occurrence of adverse events.

The Effect of Intravenous Dexamethasone and Dexmedetomidine on Analgesia Duration of Supraclavicular Brachial Plexus Block: A Randomized, Four-Arm, Triple-Blinded, Placebo-Controlled Trial

“…In recent published meta-analysis, only 10 mg of IV dexamethasone significantly prolonged analgesic duration of peripheral nerve blocks not 4 and 8 mg [27]. The same results were also shown in the recently published RCT according to dexamethasone dose in the sciatic nerve block [28]. High dose of dexamethasone may cause hyperglycemia, but the increase of blood glucose level was not significant in this study.…”

Effect of Perineural or Intravenous Betamethasone on Femoral Nerve Block Outcomes in Knee Arthroplasty: A Randomized, Controlled Study

“…Previous research has demonstrated the efficacy of intravenous injection of glucocorticoids in preventing PONV. 35 Kim et al reported no significant difference in the incidence of nausea and vomiting after sciatic nerve block between intravenous dexamethasone 2.5, 5, 10 mg, and placebo, 13 which is consistent with our results.…”

“…Among these, long‐acting glucocorticoids have shown exciting results in extending the duration of FNB. When combined with the local anesthetic ropivacaine, dexamethasone prolongs the duration of analgesia after interscalene brachial plexus blocks, sciatic nerve blocks, and popliteal nerve blocks 13–16 . In this study, betamethasone, a long‐acting corticosteroid and stereoisomer of dexamethasone, was used instead of the commonly employed dexamethasone.…”

The Effects of Intravenous Dexamethasone on Rebound Pain After Nerve Block in Patients with Ankle Fracture: A Randomized Controlled Trial

“…All nerve blocks were performed under ultrasound guidance by the same physician, skilled in nerve block techniques, which could ensure the effectiveness of the nerve block, and patients were excluded from this study if they had significant pain (NRS≥3) three hours after surgery. At present, there is no optimal dose of intravenous dexamethasone for nerve block, and this study is based on the results of Kim et al 15 …”