The effect of perineural dexamethasone on rebound pain after ropivacaine single-injection nerve block: A randomized controlled trial

Abstract

Background: Rebound pain after a single-shot nerve block challenges the real benefit of this technique. We aimed to investigate whether perineural dexamethasone addition decreased the incidence of rebound pain after a single-shot nerve block.Methods: We randomly allocated 132 patients scheduled for open reduction internal fixation of an upper extremity closed fracture under single-shot peripheral nerve block and sedation into two groups. Patients in the dexamethasone group received nerve block with 0.375% ropivacaine and 8 mg dexamethasone, while those in the control group received ropivacaine only. Sixty-three patients in the dexamethasone group and 60 patients in the control group were analyzed for the incidence of rebound pain 48 h after block administration, which was the primary outcome. The secondary outcomes included the highest self-reported numeric rating scale (NRS) score, the pain intensity at 8 h, 12 h, 24 h, and 48 h after the block, sufentanil consumption, sleep quality on the night of surgery, patient satisfaction with the pain therapy, blood glucose at 6 h after the block, and pain and paresthesia at 30 days after surgery.Results: The incidence of rebound pain was significantly lower in the dexamethasone group (7 [11.1%] of 63 patients) than in the control group (28 [48.8%] of 60 patients; relative risk (RR) of 0.238, 95% CI 0.113-0.504, p=0.001). Dexamethasone decreased opioid consumption 24 h after surgery (p<0.001) and improved the sleep quality score on the night of surgery (p=0.01) and satisfaction with pain therapy (p=0.001). Multivariate logistic regression analysis showed that only group allocation was significantly associated with the occurrence of rebound pain[OR=0.062, 95% CI (0.015-0.256)]. Patients in the dexamethasone group reported later onset pain (19.7±6.6 h vs 14.7±4.8 h since block administration, mean±SD, p<0.001) and lower peak NRS scores [5 (3, 6) vs 8 (5, 9), median (IQR), p<0.001] than those in the control group.Conclusions: The perineural administration of 8 mg dexamethasone reduces rebound pain after a single-shot nerve block in patients receiving ORIF for an upper limb fracture.Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR-IPR-17011365) on May 11th, 2017.

Comparison of intravenous or perineural dexamethasone decrease rebound pain after ropivacaine single popliteal sciatic nerve combined with femoral nerve block for ankle fracture: a prospective, randomized, placebo-controlled trial

“…This is concordant with the results in other papers. [3] However, in this study, we demonstrate that perineural or intravenous dexamethasone reduces rebound pain after nerve block in ankle surgery, regardless of route of administration.…”

“…The use of dexamethasone as an adjuvant to reduce postoperative rebound pain has been demonstrated in previous studies. [3,13] In exploring the mechanism of rebound pain, [14] Ke An and colleagues in animal study founded transient rebound hyperalgesia to thermal after the resolution of mouse sciatic block with bupivacaine, and bupivacaine-induced axon degeneration and Schwann cell response in early phase; At the same time, they demonstrated the perineural dexamethasone could prevent neurotoxicity and rebound hyperalgesia after nerve block. It is important to note that the authors suggest that perineural rather than the systemic application of dexamethasone may prevent rebound and pain.…”

“…In some studies, perineural administration of dexamethasone as an adjuvant could be prevent rebound pain after PNB [3]. In the operating room, anesthesiologists usually add dexamethasone to local anaesthetics to prolong the duration of single-shot PNB.…”

A Bioinformatics Study of Ropivacaine plus Dexamethasone Prolonging the Duration of Nerve Block

“…One researcher evaluated over 1,000 peripheral nerve blocks and discovered a median block duration of 15 h with ropivacaine alone in contrast to 22 hours when 4 /8 mg perineural dexamethasone was additionally used [9]. In addition, they lowered the intensity of pain at what surgical patients mentioned as the worst pain point after the block and improved patient satisfaction with postoperative pain management [10]. It has been suggested that this may be due to the ability of glucocorticoids to cause local vasoconstriction in individuals to slow the absorption of local anesthetic drugs.…”