Perineural dexamethasone

PURPOSE: Glucocorticoids are commonly used as regional anesthesia adjuvants to improve blockade quality and duration. There are limited data in the literature regarding the potential systemic effects and safety of perineural glucocorticoids. This study examines the effects of perineural glucocorticoids on serum glucose, potassium, and white blood cell count (WBC) in the immediate postoperative period after primary total hip arthroplasty (THA). PATIENTS AND METHODS: A retrospective cohort study was carried out at a tertiary academic medical center utilizing electronic health records of 210 patients who underwent THA, for which patients received either a periarticular local anesthetic injection alone (PAI, N=132) or additional peripheral nerve blocks (PNB, N=78) containing 10 mg dexamethasone and 80 mg methylprednisolone acetate (PAI+PNB)...

The combination of drugs and routes of administration produces a synergistic effect, and one of the most important components of multimodal analgesic strategies are, therefore, nerve blocks for pain management. The effect of a local anaesthetic can be prolonged by administering an adjuvant. In this systematic review, we included studies on adjuvants associated with local anaesthetics in peripheral nerve blocks published in the last 5 years in order to evaluate their effectiveness. The results were reported according to the PRISMA guidelines...

OBJECTIVE: To summarize the research progress of the analgesic effect of adductor canal block (ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. METHODS: The research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. RESULTS: In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty...

CONTEXT: Ultrasound-guided bilateral superficial cervical plexus block (BSCPB) is a technique described for thyroid surgeries for postoperative analgesia as the surgery can cause severe pain and discomfort. Perineural dexamethasone is known to prolong analgesic duration and reduce postoperative nausea/vomiting. AIMS: To assess the efficacy of dexamethasone as an adjuvant to BSCPB with 0.25% bupivacaine on isoflurane consumption, intraoperative hemodynamic parameters, and postoperative analgesia in patients undergoing thyroid surgeries under general anesthesia...

PURPOSE: Opioid consumption after total knee arthroplasty (TKA) remains a challenge with single injection nerve blocks even with common local anesthetic adjuvants dexamethasone (DEX). This study aimed to investigate the effects of adding methylprednisolone acetate (MPA) to adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks on postoperative opioid consumption. METHODS: A retrospective analysis was conducted on 100 consecutive TKA patients equally assigned into two groups, with one group receiving DEX through ACB and iPACK block and the other group receiving DEX and methylprednisolone acetate (DEX/MPA) through the same nerve blocks...

Purpose: The goal of this study was to evaluate the analgesic efficiency of dexamethasone with ropivacaine in continuous serratus anterior plane block (cSAPB) after video-assisted thoracoscopic surgery (VATS). Patients and Methods: Sixty-six patients who underwent VATS were randomized into two groups. All patients received cSAPB postoperatively, and patients in Group RD received 20 mL of 0.375% ropivacaine plus 0.1 mg/kg dexamethasone followed by an infusion of 0...

PURPOSE: The purpose of this study is to determine if using a combination of dexamethasone and dexmedetomidine (Dex-Dex) in a single-shot perineural local anesthestic provides an increased duration of pain relief and reduced consumption of opioids for patients undergoing shoulder surgery. PATIENTS AND METHODS: This is a retrospective trial of adult patients without major comorbidities undergoing elective, upper arm orthopedic procedures with regional nerve block for post-operative analgesia...

Interscalene block is applied to control acute postoperative pain after arthroscopic rotator cuff repair (ARCR), typically with single-shot interscalene block (SSIB) or continuous interscalene indwelling catheter analgesia (IICA), and dexamethasone (Dex) for extending the analgesic effect. This study investigated whether perineural Dex can extend the postoperative analgesic effect of SSIB to match that of IICA. A total of 130 patients were recruited and divided into two groups (Group D, SSIB with perineural Dex, n = 94; Group C, IICA, n = 36)...

INTRODUCTION: Amino-amide local anesthetics precipitate when mixed with some commonly used adjuvants, carrying the risk of perineural or vascular crystal deposition. The aim of this study was to evaluate whether crystallization occurs with routinely used local anesthetic-adjuvant combinations and if a relation with the solution's pH exists. METHODS: All substances used in this trial were first visually investigated undiluted under tenfold magnification. Grade of crystallization was assessed using a 6 point grading system...

PURPOSE: Postoperative sore throat (POST) is a common complaint following thyroidectomy. Dexamethasone was reported to alleviate POST when administered via different routes. This study aimed to compare the effects of local spray and perineural injection surrounding the internal branch of superior laryngeal nerve (iSLN) in preventing POST and alleviating postoperative impaired voice function. METHODS: A randomized, double-blinded, controlled trial was performed to test the efficacy of the iSLN block in inhibiting of POST...

BACKGROUND: This randomized trial compared perineural dexamethasone with combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block. We hypothesized that the combination of perineural adjuvants would result in a longer motor block. METHODS: Fifty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block (using 35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (2 mg) or combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg)...

Dexamethasone supplementation to local anesthetics prolongs its action, yet the underlying mechanism is unclear. Previous studies have reported that increased p-p38 mitogen-activated protein kinase (MAPK) in the dorsal root ganglia (DRG) is associated with pain-associated behavior and that nitric oxide (NO), which is known to be a pronociceptive substance, directly inhibits sciatic nerve conduction. Here, we investigated the temporal changes in the hyperalgesic effect and p-p38 MAPK and NO synthase (NOS) expression levels in the DRG when dexamethasone was added to ropivacaine used for a sciatic nerve block (SNB) in postoperative pain model mice...

Efforts to prolong thoracic paravertebral block (TPVB) analgesia include local anesthetic adjuvants, such as dexamethasone (Dex). Previous studies showed that both perineural (PN) and intravenous (i.v.) routes could prolong analgesia. As PN Dex is an off-label use, anesthesiologists should be fully informed of the clinical differences, if any, on block duration. This study was designed to evaluate the two administration routes of Dex for duration of analgesia in TPVB. Ninety-five patients scheduled for Ivor-Lewis esophagectomy were randomized to receive TPVB (0...

BACKGROUND: Rebound pain occurs after up to 50% of ambulatory surgeries involving regional anaesthesia. To assist with risk stratification, we developed a model to predict severe rebound pain after foot and ankle surgery involving single-shot popliteal sciatic nerve block. METHODS: After ethics approval, we performed a single-centre retrospective cohort study. Patients undergoing lower limb surgery with popliteal sciatic nerve block from January 2016 to November 2019 were included...

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Background Postoperative pain management in pediatric population can be very challenging. How to prolong the duration of single-injection peripheral nerve blocks has been widely discussed. Multiple medications are under investigation to accomplish this, yet data specifically focused on their use in pediatric peripheral nerve blocks are limited. Methods Anesthetic electronic medical records were queried for any instances where adjuvant drug(s) were used in peripheral nerve blocks during a two-year period at a pediatric surgical specialty hospital...

INTRODUCTION: The use of glucocorticoid as local anesthetic adjuvant in single-injection adductor canal block (ACB) is well-documented but its effects in the presence of an indwelling catheter is unclear. The purpose of this study was to determine the impacts of one-time perineural glucocorticoid injection on continuous adductor canal block in patients undergoing total knee arthroplasty. METHODS: A single center retrospective study of 95 patients undergoing unilateral total knee arthroplasty (TKA) was performed...

BACKGROUND: The interscalene nerve block provides analgesia for shoulder surgery. To extend block duration, provide adequate analgesia, and minimize opioid consumption, the use of adjuvants such as dexamethasone as well as the application of perineural liposomal bupivacaine have been proposed. This randomized, double-blinded, noninferiority trial hypothesized that perineural liposomal bupivacaine is noninferior to standard bupivacaine with perineural dexamethasone in respect to average pain scores in the first 72 h after surgery...

Background: Perineural dexamethasone is regarded as a promising adjunct for prolonging nerve block duration. However, it is uncertain if its effects are from a local effect on the nerves or from systemic absorption of the anti-inflammatory drug. This systematic review aims to compare the impact of perineural dexamethasone vis-a-vis intravenous dexamethasone, as an adjunct to peripheral nerve blocks, on the duration of analgesia postoperatively. Methods: A total of 2,216 relevant academic articles were identified by comprehensively searching the major databases (PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials...

BACKGROUND: Acute pain is one of the most common complaints encountered in the emergency department (ED). Single-injection peripheral nerve blocks are a safe and effective pain management tool when performed in the ED. Dexamethasone has been explored as an adjuvant to prolong duration of analgesia from peripheral nerve blocks in peri- and postoperative settings; however, data surrounding the use of dexamethasone for ED-performed nerve blocks are lacking. CASE SERIES: In this case series we discuss our experience with adjunctive perineural dexamethasone in ED-performed regional anesthesia...