Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks

Abstract

Perineural dexamethasone prolongs the duration of analgesia across the RCTs included in our meta-analysis. The magnitude of effect of 3.77 hours raises the question as to whether perineural dexamethasone should be administered routinely over its IV counterpart-or reserved for selected patients where such prolongation would be clinically important.

Analgesia of Combined Femoral Triangle and Obturator Nerve Blockade Is Superior to Local Infiltration Analgesia After Total Knee Arthroplasty With High-Dose Intravenous Dexamethasone

“…Perineural injection of dexamethasone prolongs the duration of analgesia compared with intravenous administration of dexamethasone. 15 The opioid-sparing effect of glucocorticoids is pronounced during the postoperative pain management, achieving the optimal effect when glucocorticoids are administered prior to anesthesia. 2, 16 We administered 16 mg of dexamethasone intravenously prior to anesthesia in all patients in our study, approximately equivalent to 0.1 to 0.2 mg/kg.…”

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

“…This point is still a matter of debate and controversy. 12,13 In patients having an ankle block for metatarsal osteotomy, this study aims to determine if perineural dexamethasone compared with systemic dexamethasone reduces analgesic requirements during the postoperative period.…”

Blinded by certainties

“…Baeriswyl claims in his recent meta-analysis ‘moderate evidence that perineural dexamethasone combined with bupivacaine, but not ropivacaine , slightly prolongs the duration of analgesia’ 7. Chong meta-analysis suggests that ‘perineural dexamethasone prolonged the duration of analgesia….compared with intravenous dexamethasone, with high statistical heterogeneity ’ 8. This heterogeneity was highly expected as different local anesthetics, surgical procedures and doses of dexamethasone are pooled together.…”