Perineural versus intravenous dexamethasone as an adjuvant in regional anesthesia: a systematic review and meta-analysis

Abstract

BackgroundDexamethasone is a common adjuvant for local anesthetics in regional anesthesia, but the optimal route of administration is controversial. Therefore, we did a systematic review and meta-analysis of randomized controlled trials to assess the effect of perineural versus intravenous dexamethasone on local anesthetic regional nerve-blockade outcomes.Materials and methodsMedline (through PubMed), Embase, Cochrane, Web of Science, and Biosis Previews databases were systematically searched (published from inception of each database to January 1, 2017) to identify randomized controlled trials. The data of the selected trials were statistically analyzed to find any significant differences between the two modalities. The primary outcome was the duration of analgesia. Secondary outcomes included duration of motor block, postoperative nausea and vomiting, and postoperative analgesic dose at 24 hours. We conducted a planned subgroup analysis to compare the effects between adding epinephrine or not.ResultsTen randomized controlled trials met the inclusion criteria of our analysis, with a total of 749 patients. Without the addition of epinephrine, the effects of perineural and intravenous dexamethasone were equivalent concerning the duration of analgesia (mean difference 0.03 hours, 95% CI –0.17 to 0.24). However, with the addition of epinephrine, the analgesic duration of perineural dexamethasone versus intravenous dexamethasone was prolonged (mean difference 3.96 hours, 95% CI 2.66–5.27). Likewise, the impact of epinephrine was the same on the duration of motor block. The two routes of administration did not show any significant differences in the incidence of postoperative nausea and vomiting, nor on postoperative analgesic consumption at 24 hours.ConclusionOur results show that perineural dexamethasone can prolong the effects of analgesic duration when compared to the intravenous route, only when epinephrine is coadministered. Without epinephrine, the two modalities show equivalent effect as adjuvants on regional anesthesia.

Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised, triple-blinded crossover study in volunteers

“…1e7 It was suggested that dexamethasone may have a small effect to increase the duration of peripheral regional blocks, but this may apply only when the local anaesthetic solution contains epinephrine. 7 We suggested that the low quality of the trials included in the metaanalyses and the heterogeneity between them (different local anaesthetics, with or without epinephrine, different doses of dexamethasone, different blocks, etc.) meant that no reliable conclusions could be drawn regarding the efficacy of perineural dexamethasone in combination with local anaesthetics.…”

A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision

“…For larger diameter and more complex bundles of nerves, macroscopic volume alterations and distribution become increasingly important and contribute to blurring of this dose‐dependent effect . In meta‐analyses, dexamethasone has been shown to have both primary analgesic and block‐enhancing effects (intravenously or perineural) . Its equivalent role in children is less well investigated but some studies suggest either the same or a greater impact on analgesia .…”

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

“…This was comparable with our finding when an opioid conversion factor of morphine to tramadol is applied (1:10). Zhao et al also showed the two routes of administration (intravenous and perineural) did not show any significant difference in post op analgesic consumption (19).…”