Perineural Dexamethasone and Multimodal Perineural Analgesia

Intravenous Dexamethasone and Perineural Dexamethasone Similarly Prolong the Duration of Analgesia After Supraclavicular Brachial Plexus Block

“…[31][32][33][34] Dexamethasone is also believed to suppress the neuropeptide immune response in injured tissue, thus lessening the extent of pain. 35 There are a number of limitations associated with the present study. First, a number of patients required distal supplementation with lidocaine 2% to hasten block onset because of operating room readiness and patient flow efficiencies.…”

“…Finally, the present study was not powered to detect complications of perineural dexamethasone. Bench studies investigating the safety of perineural dexamethasone suggest a dosedependent adverse effect on peripheral nerves, 35 although a more recent study by Williams and colleagues suggests that the neurotoxicity of a dexamethasone-ropivacaine combination is similar to that of ropivacaine alone. 8 An additional concern includes the possibility of a reduction in blood flow associated with the perineural application of dexamethasone; this may have important implications if perineural dexamethasone is coadministrated with epinephrine and/or used in diabetic patients.…”

Clinical Benchmarks Regarding Multimodal Peripheral Nerve Blocks for Postoperative Analgesia: Observations Regarding Combined Perineural Midazolam-Clonidine-Buprenorphine-Dexamethasone

“…Our QA/QI data indicated less variance in associated block duration of MDZ‐CBD when 2 mg (as opposed to 1 mg) of perineural dexamethasone was used. Elsewhere [19], we have recommended that preservative‐free dexamethasone (combined with local anesthetics and clonidine‐buprenorphine) should be restricted to 1–2 mg per nerve (as opposed to the 4–8 mg dexamethasone dose that had been reported elsewhere [20] in the literature). This is because of the neurocytotoxicity risk, in vitro, of using higher concentrations of dexamethasone when combined with local anesthetics [3].…”

Pain Management for Ambulatory Surgery: What Is New?

“…Animal studies have demonstrated that dexamethasone did not increase the neurotoxicity of ropivacaine when added at a concentration of 66 lg/ml to a 24 h infusion, but significantly increased neurotoxicity at 133 lg/ml [71 •• ]. Thus limiting perineural dexamethasone concentrations to 66 lg/ ml, and taking into account any systemically administered dexamethasone upto a maximum of 4 mg per patient is suggested by Williams et al [72] in a recent editorial.…”