Eur J Anaesthesiol. 2015 Nov;32(11):751-8. doi: 10.1097/EJA.0000000000000248.
AUTHORS:Huynh TM et al
BACKGROUND:
Dexamethasone decreases postoperative pain and prolongs the duration of local anaesthetic peripheral nerve blocks in studies including a limited number of patients.
OBJECTIVE:
The objective of this study is to evaluate the effect of combining dexamethasone with local anaesthetic on sensory and motor peripheral nerve blockade in adults.
DESIGN:
A systematic review with meta-analysis of randomised controlled trials.
DATA SOURCES:
We systematically searched in Medline, Embase, Google Scholar and Cochrane Controlled Trials Register up to December 2013.
ELIGIBILITY CRITERIA:
Randomised trials testing dexamethasone combined with local anaesthetic.
RESULTS:
Twelve trials (1054 patients, 512 receiving perineural dexamethasone) were included. Ten studies evaluated dexamethasone for brachial plexus nerve block. Four to 10 mg dexamethasone-containing local anaesthetic solutions had a faster onset of action and resulted in a significant increase in the duration of analgesia [weighted mean difference (WMD) 351 min, 95% confidence interval (95% CI) 288 to 413, P < 0.001] and motor blockade (WMD 277 min, 95% CI 167 to 387, P < 0.001) compared with local anaesthetic solutions alone. Time to onset of sensory and motor blocks was significantly reduced with dexamethasone (WMD -78 s, 95% CI -112 to -44, and -90 s, 95% CI -131 to -48, respectively). Dexamethasone significantly decreased postoperative nausea and vomiting (PONV, 9 vs. 27%, relative risk 0.36, 95% CI 0.19 to 0.70). Subgroup analyses showed that dexamethasone approximately doubled the duration of postoperative analgesia when it was combined with intermediate-acting (lidocaine, mepivacaine) or long-acting (bupivacaine, ropivacaine) local anaesthetics.
CONCLUSION:
Combining dexamethasone with local anaesthetics results in a prolongation of the duration of peripheral nerve block.
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