Optimal Dose of Perineural Dexamethasone to Prolong Analgesia After Brachial Plexus Blockade: A Systematic Review and Meta-analysis

Abstract

There is currently very low quality evidence that 4 mg of perineural dexamethasone represents a ceiling dose that prolongs analgesia duration by a mean period of 6 and 8 hours when combined with short-/intermediate- or long-acting local anesthetics, respectively. Additional data are needed to explore the threshold for this effect, particularly with doses below 4 mg. The risk of neurologic complications is probably not increased (very low evidence).

Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple‐blind trial

“…The slightly increased postoperative blood glucose of 0.6 mmol.l −1 is not clinically relevant, although caution is warranted with dexamethasone administration in diabetic patients. An increased duration of motor blockade in patients receiving dexamethasone has also been reported in the literature previously; as it is not clear whether the mechanism of perineural dexamethasone effect is a local action on the neurons or a systemic effect , it is difficult to provide an explanation. We relied on the patient's assessment for characteristics of motor block; it is possible that the patient first perceived return of motor function at the same time that they felt pain onset during the night, leading to the possibility of bias.…”

“…Perineural dexamethasone combined with long‐acting local anaesthetic prolongs analgesia by 8 h, at the expense of a slight increase in blood glucose concentration . A recent meta‐analysis, including 2138 participants, showed a ceiling dose of 4 mg for perineural administration . Of note, the doses used in the 33 included trials ranged from 4 to 10 mg, without robust evidence for the selected dose.…”

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

“…However, based on previous findings, we decided to compare the supposed optimal ceiling dose of both perineural and systemic dexamethasone that prolongs analgesia duration. [23][24][25] Finally, our study was not designed to assess neural toxicity of dexamethasone. There is a lack of data regarding this complex issue.…”

Perineural adjuncts for peripheral nerve block

“…Perineural dexamethasone was shown to decrease pain scores at rest and on movement, and reduce cumulative morphine consumption at 24 h. In the setting of brachial plexus block, increases in the dose of perineural dexamethasone prolongs the duration of analgesia in a dose-dependent manner until the ceiling dose of 4 mg is reached. 4 Dexamethasone has been associated with an increase in postoperative blood glucose concentration in diabetic and non-diabetic patients. 5 Concerns about the potential to cause delayed wound healing and systemic or wound infection have not been confirmed in a recent meta-analysis.…”