Korean J Anesthesiol.
2022 Jun;75(3):255-265. 10.4097/kja.21390.
Efficacy of perineural versus intravenous dexamethasone in prolonging the duration of analgesia when administered with peripheral nerve blocks: a systematic review and meta-analysis
- Affiliations
-
- 1Department of Pain Medicine, Singapore General Hospital, Singapore
- 2Department of Anesthesiology, Singapore General Hospital, Singapore
- 3Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
- KMID: 2530013
- DOI: http://doi.org/10.4097/kja.21390
Abstract
- Background
Perineural dexamethasone has been regarded as a promising adjunct for prolonging the duration of nerve blocks. However, it is uncertain whether its effects are due to local effects on the nerves or from systemic absorption. This systematic review aimed to compare the duration of postoperative analgesia associated with perineural versus intravenous dexamethasone as an adjunct to peripheral nerve blocks.
Methods
A total of 2,216 relevant academic articles were identified after a comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1967 until 2020. All randomized controlled trials that compared perineural and intravenous dexamethasone as adjuncts to peripheral nerve limb blocks were included.
Results
Fifteen randomized controlled trials (1,467 cases; 738 perineural dexamethasone, 729 intravenous dexamethasone) were eligible. The primary outcome (duration of analgesia) was significantly longer in the perineural than in the intravenous dexamethasone group (mean difference [MD]: 2.72 h, 95% CI [1.42, 4.01], P < 0.001). Perineural dexamethasone was also found to prolong the sensory block (MD: 3.45 h, 95% CI [1.36, 5.54], P = 0.001) and lower 24 h postoperative pain scores (MD: −0.74 h, 95% CI [−1.40, −0.07], P = 0.03).
Conclusions
This review confirms the greater efficacy of perineural compared to intravenous dexamethasone in prolonging the analgesic duration of peripheral nerve blocks. However, the extent of prolongation was small and may not represent a clinically meaningful difference.
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Adjuvant medications to local anesthetics in nerve blockade
- Effect of intravenous dexamethasone on the duration of postoperative analgesia for popliteal sciatic nerve block: a randomized, double-blind, placebo-controlled study
- Intravenous Versus Perineural Dexamethasone for Reducing Rebound Pain After Interscalene Brachial Plexus Block: A Randomized Controlled Trial
- Nerve blocks for optimal postoperative analgesia after total knee arthroplasty
- Continuous peripheral nerve blocks compared to thoracic epidurals or multimodal analgesia for midline laparotomy: a systematic review and meta-analysis
