Authors: Reysner T et al.
Journal of Clinical Anesthesia. 2025.
Summary
This randomized, triple-blinded clinical trial evaluated whether intravenous dexamethasone prolongs analgesia following single-shot popliteal nerve block in pediatric patients undergoing foot or ankle surgery. Postoperative pain control in this population is often limited by the short duration of peripheral nerve blocks, and evidence supporting systemic adjuncts in pediatric regional anesthesia remains limited. The investigators compared two doses of intravenous dexamethasone with placebo to assess efficacy and safety.
Ninety pediatric patients were randomized to receive placebo, 0.1 mg/kg dexamethasone, or 0.2 mg/kg dexamethasone prior to block placement. Both dexamethasone doses significantly prolonged the opioid-free interval compared with placebo, with the longest duration observed in the 0.2 mg/kg group. Total postoperative opioid consumption was also lowest in the higher-dose group. Pain scores measured using standardized pediatric scales were consistently lower in both dexamethasone groups, and postoperative inflammatory markers, including neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, were reduced in a dose-responsive manner.
Metabolic effects were observed, with dose-dependent increases in postoperative blood glucose levels. However, no clinically significant adverse events were reported. Dexamethasone use was associated with delayed motor recovery, suggesting a tradeoff between prolonged analgesia and functional recovery. The authors conclude that intravenous dexamethasone is an effective adjunct to popliteal nerve block in pediatric foot and ankle surgery, with lower dosing potentially offering a favorable balance between analgesic benefit and metabolic effects.
What You Should Know
Intravenous dexamethasone significantly prolongs analgesia after popliteal nerve block in pediatric ankle and foot surgery.
A 0.2 mg/kg dose provides greater opioid sparing and longer pain relief than 0.1 mg/kg.
Dexamethasone causes mild, dose-dependent hyperglycemia without reported adverse clinical events.
Lower-dose dexamethasone may balance analgesic benefit with metabolic safety and faster motor recovery.
Key Points
Question: Does intravenous dexamethasone prolong analgesia after popliteal nerve block in pediatric foot and ankle surgery?
Findings: Both low- and moderate-dose dexamethasone prolonged opioid-free analgesia and reduced opioid use compared with placebo.
Meaning: Systemic dexamethasone is an effective adjunct to pediatric regional anesthesia, though dosing should consider metabolic effects and recovery profiles.
Thank you to the Journal of Clinical Anesthesia for allowing us to summarize this article.