• Zih-Sian Yang, Hou-Chuan Lai, Hong-Jie Jhou, Wei-Hung Chan, and Po-Huang Chen.
• Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
• J Clin Anesth. 2024 Oct 24; 99: 111657111657.

Study ObjectivePeripheral nerve blocks (PNBs) are widely used for postoperative analgesia, but rebound pain following block resolution poses a significant clinical challenge. Dexamethasone, administered either intravenously (IV) or perineurally, has shown promise in reducing rebound pain incidence, but the optimal route remains unclear. This network meta-analysis (NMA) aims to compare the effectiveness of different routes of dexamethasone administration, including IV, perineural, and control, in reducing the incidence of rebound pain following PNBs.DesignNetwork meta-analysis.SettingOperating room, postoperative recovery area and ward.PatientsSeven randomized controlled trials involving 561 patients undergoing peripheral nerve block for postoperative pain management.InterventionsIntravenous and perineural dexamethasone compared to control for preventing rebound pain.MeasurementsThe primary outcome was the incidence of rebound pain. Secondary outcomes included median time to first analgesic request, rebound pain resolution time, difference in pain scores before and after PNB resolution, and nausea/vomiting.Main ResultsBoth IV and perineural dexamethasone significantly reduced the incidence of rebound pain following peripheral nerve blocks compared to the control group. IV dexamethasone ranked first based on P-score (OR, 0.13; 95 % CI, 0.07-0.23; P-score, 0.92). Secondary outcomes, including time to the first analgesic request, pain score difference, and nausea/vomiting, also favored both IV and perineural dexamethasone over the control group.ConclusionBoth IV and perineural dexamethasone are preferred over no dexamethasone for preventing rebound pain after PNBs, with IV dexamethasone being the more effective route. Despite limitations, these findings provide valuable insights for clinical decision-making in postoperative pain management.Systematic Review RegistrationPROSPERO CRD42024530943.Copyright © 2024. Published by Elsevier Inc.

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