JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL
RESEARCH SUPPORT, NON-U.S. GOV'T
Add like
Add dislike
Add to saved papers

The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Perineural dexamethasone has been investigated as an adjuvant for brachial plexus nerve blocks, but it is not known whether the beneficial effect of perineural dexamethasone on analgesia duration leads to a better quality of surgical recovery. We hypothesized that patients receiving dexamethasone would have a better quality of recovery than patients not receiving dexamethasone. We also sought to compare the effect of perineural with that of IV dexamethasone on block characteristics.

METHODS: Patients undergoing elective ankle and foot surgery were recruited over a 9-month period. Patients received ultrasound-guided sciatic nerve blocks by using 0.5% bupivacaine with epinephrine 1:300,000 (0.45 mL/kg) and were randomized into 3 groups: group 1 = perineural dexamethasone 8 mg/2 mL with 50 mL IV normal saline, group 2 = perineural saline/2 mL with IV 8 mg dexamethasone in 50 mL normal saline, and group 3 = perineural saline/2 mL with 50 mL normal saline. The primary outcome was the global score in the quality of recovery (QoR-40). The secondary outcomes included analgesia duration, opioid consumption, patient satisfaction, numeric pain rating scores, and postoperative neurologic symptoms.

RESULTS: Eighty patients were randomized, and 78 patients completed the study protocol. There was no improvement in the global QoR-40 score at 24 hours between the perineural dexamethasone and saline, median (97.5% CI) difference of -3 (-7 to 3); IV dexamethasone and saline, median difference of -1 (-8 to 5); or perineural dexamethasone and IV dexamethasone median difference of -2 (-6 to 5). Analgesia duration (P < 0.001) and time to first toe movement (P < 0.001) were prolonged by perineural dexamethasone compared with saline. IV dexamethasone prolonged time to first toe movement compared with saline (P = 0.008) but not analgesia duration (P = 0.18). There was no significant difference in the time to first toe movement or analgesia duration between the perineural and IV dexamethasone groups. Postoperative opioid consumption was not different among study groups. Self-reported neurologic symptoms at 24 hours were not different among perineural dexamethasone (17, 63%), IV dexamethasone (10, 42%), or normal saline (8, 30%) (P = 0.31). All postoperative neurologic sequelae were resolved by 8 weeks.

CONCLUSIONS: Preoperative administration of IV and perineural dexamethasone compared with saline did not improve overall QoR-40 or decrease opioid consumption but did prolong analgesic duration in patients undergoing elective foot and ankle surgery and receiving sciatic nerve block. Given the lack of clinical benefit and the concern of dexamethasone neurotoxicity as demonstrated in animal studies, the practice of perineural dexamethasone administration needs to be further evaluated.

Full text links

We have located links that may give you full text access.
Can't access the paper?
Try logging in through your university/institutional subscription. For a smoother one-click institutional access experience, please use our mobile app.

For the best experience, use the Read mobile app

Mobile app image

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

By using this service, you agree to our terms of use and privacy policy.

Your Privacy Choices Toggle icon

You can now claim free CME credits for this literature searchClaim now

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app