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Review
. 2014:2014:179029.
doi: 10.1155/2014/179029. Epub 2014 Nov 18.

Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials

Gildasio S De Oliveira Jr  1 , Lucas J Castro Alves  1 , Autoun Nader  1 , Mark C Kendall  1 , Rohit Rahangdale  1 , Robert J McCarthy  1
Affiliations
Review

Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials

Gildasio S De Oliveira Jr et al. Pain Res Treat. 2014.

Abstract

Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI) of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682) minutes, and motor block duration, 500 (154 to 846) minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, -8.5 (-12.3 to -4.6) mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug.

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Figures

Figure 1
Figure 1
Flow chart outlining retrieved, excluded, and evaluated randomized controlled trials. Some trials evaluated multiple doses of dexamethasone.
Figure 2
Figure 2
Pooled data evaluating the effect of perineural dexamethasone on analgesia duration compared to control. Data evaluated using a random effects model. Point estimate (99% CI) for overall effect was 473 (264 to 682) minutes. Weighted mean difference for individual study represented by square on forest plot with 99% confidence interval of the difference shown as solid line. Larger sized square and thicker 99% confidence interval line denote larger sample size. The diamond represents the pooled estimate and uncertainty for the effects of perineural dexamethasone compared to control.
Figure 3
Figure 3
Pooled data evaluating the effect of perineural dexamethasone on postoperative opioid consumption compared to control. Data evaluated using a random effects model. Point estimate (99% CI) for overall effect was −8.5 (−12.3 to −4.6) mg of IV morphine equivalents. Weighted mean difference for individual study represented by square on forest plot with 99% confidence interval of the difference shown as solid line. Larger sized square and thicker 99% confidence interval line denote larger sample size. The diamond represents the pooled estimate and uncertainty for the effects of perineural dexamethasone compared to control.
Figure 4
Figure 4
Pooled data evaluating the effect of perineural dexamethasone on motor block duration compared to control. Data evaluated using a random effects model. Point estimate (99% CI) for overall effect was 500 (154 to 846) min. Weighted mean difference for individual study represented by square on forest plot with 99% confidence interval of the difference shown as solid line. Larger sized square and thicker 99% confidence interval line denote larger sample size. The diamond represents the pooled estimate and uncertainty for the effects of perineural dexamethasone compared to control.
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