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Meta-Analysis
. 2022 Jun;75(3):255-265.
doi: 10.4097/kja.21390. Epub 2021 Dec 29.

Efficacy of perineural versus intravenous dexamethasone in prolonging the duration of analgesia when administered with peripheral nerve blocks: a systematic review and meta-analysis

Elizabeth Sein Jieh Tan  1 , Yan Ru Tan  2 , Christopher Wei Yang Liu  1   3
Affiliations
Meta-Analysis

Efficacy of perineural versus intravenous dexamethasone in prolonging the duration of analgesia when administered with peripheral nerve blocks: a systematic review and meta-analysis

Elizabeth Sein Jieh Tan et al. Korean J Anesthesiol. 2022 Jun.

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.

Keywords: Acute pain; Conduction anesthesia; Enhanced recovery after surgery; Nerve block; Pharmaceutic adjuvants; Postoperative pain.

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram.
Fig. 2.
Fig. 2.
Risk of bias table of included studies.
Fig. 3.
Fig. 3.
Forest plot of perineural vs. intravenous dexamethasone; duration of analgesia in hours.
Fig. 4.
Fig. 4.
Forest plot of subgroup analysis of time to first pain sensation in hours for perineural vs. intravenous dexamethasone.
Fig. 5.
Fig. 5.
Forest plot of subgroup analysis of time to first analgesic request in hours for perineural vs. intravenous dexamethasone.
Fig. 6.
Fig. 6.
Forest plot of 12 h postoperative pain scores for perineural vs. intravenous dexamethasone.
Fig. 7.
Fig. 7.
Forest plot of 24 h postoperative pain scores for perineural vs. intravenous dexamethasone.
Fig. 8.
Fig. 8.
Forest plot of 24 h oral morphine equivalent consumption in mg for perineural vs. intravenous dexamethasone.
See this image and copyright information in PMC

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