Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis

Hussain, Nasir; Langenbergh, Tom Van den; Sermer, Corey; Fontes, Manuel L.; Atrey, Amit; Shaparin, Naum; Sawyer, Tamara R.; Vydyanathan, Amaresh

doi:10.1007/s12630-017-1008-8

Cited by 37 publications

(25 citation statements)

References 44 publications

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“…A meta-analysis by Choi et al showed that the use of perineural dexamethasone significantly prolonged the duration of analgesia approximately by 6 hours compared to the use of IV dexamethasone. A recent meta-analysis by Hussein et al showed that irrespective of dose, the use of perineural dexamethasone does not appear to provide a significant incremental benefit to the pain score, duration of analgesia or motor blockade, and cumulative opioid consumption when compared to the use of IV dexamethasone at a 24-hour follow-up ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…This suggests adding dexamethasone cautiously in diabetic patients although this hypothesis must be confirmed by further research in this patient population. Williams et al evaluated the toxicity of perineural adjuvants to ropivacaine in an animal model and proved the administration of supratherapeutic doses of dexamethasone for two hours did not appear to cause neuronal cell death ( 12 ). Future studies should focus on evaluating the dose-dependent analgesic effects of perineural or interfascial dexamethasone addition.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy

et al. 2018

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BackgroundPostoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action.ObjectivesThis study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy.MethodsA prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded.ResultsPatients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001).ConclusionsThe three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy

et al. 2018

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“…Furthermore, another study also showed perineural and intravenous dexamethasone has equivalent analgesic benefits and similar safety profiles when used an adjuvant to peripheral nerve block (13).…”

Section: Incidence Of Postoperative Complicationsmentioning

confidence: 93%

Effectiveness of perineural and intravenous dexamethasone added to bupivacaine for transversus abdominis plane block in post-cesarean delivery pain control: a prospective cohort study, 2019

Jemal

Zemedkun

Admasu

et al. 2020

Preprint

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Background Caesarean delivery (CD) has been one of the most frequently performed major surgical interventions, and causes severe postoperative pain. Abdominal field blocks like TAP block are mostly preferred as post-operative analgesia for this operation. Using different adjuvants like dexamethasone by different routes increases the quality and duration of block and maximizes patient satisfaction. The objective of this study was to compare the effectiveness between perineural and intravenous dexamethasone as an adjuvant on bilateral transversus abdominis plane block for post cesarean delivery pain control. Methodology An institutional based prospective cohort study was conducted on 87 patients. Study participants were selected by systematic random sampling technique. Data collection methods include preoperative chart review, intraoperative observation and postoperative patient interview at 4 th , 6 th , 8 th , 12 th and 24 th hours. Sociodemographic variable were analyzed by ANOVA and chi square test. Kruskal Wallis with post hoc analysis was used to compare post-operative severity of pain score and cumulative analgesic consumption. Time to first analgesic request was analyzed using Kaplan Meier survival analysis with log rank. Categorical variable were analyzed by chi square. Result Time to first analgesic request was significantly longer in TAP-IVD and TAP-PD compared to TAP alone (p < 0.05). The postoperative NRS score at rest and on coughing were significantly lowered in TAP-PD and TAP-IVD group compared to TAP alone group (p <0.05).The total analgesic consumption in the first 24h was significantly lower in TAP-IVD and TAP-PD group compared to TAP alone group (p < 0.05). Conclusion and recommendation dexamethasone 8mg both intravenously and perineurally is effective adjuvant to bupivacaine on bilateral TAP block with prolonged and potent analgesia and reduced analgesic consumption. Based on our finding we recommend use of dexamethasone as an adjuvant to bupivacaine on bilateral transversus abdominis plane block.

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“…route. 22 Surprisingly, in a recent study of healthy volunteers, addition of perineural or i.v. dexamethasone to ulnar nerve block with ropivacaine did not show any significant benefits over saline.…”

Section: Comparison Of the Perineural And Systemic Routes Of Adjunct mentioning

confidence: 98%

Perineural adjuncts for peripheral nerve block

2019

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Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis

Abstract: The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade.

Cited by 37 publications

References 44 publications

Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy

Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy

Effectiveness of perineural and intravenous dexamethasone added to bupivacaine for transversus abdominis plane block in post-cesarean delivery pain control: a prospective cohort study, 2019

Perineural adjuncts for peripheral nerve block

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