Dexamethasone doubled the duration of postoperative analgesia after brachial plexus block, as well as speeding onset and reducing PONV.

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• Thi Mum Huynh, Emmanuel Marret, and Francis Bonnet.
• From the Department of Anaesthesiology and Intensive Care, Tenon Hospital, Assistance Publique Hôpitaux de Paris, Pierre and Marie Curie University, Paris, France.
• Eur J Anaesthesiol. 2015 Nov 1; 32 (11): 751-8.

BackgroundDexamethasone decreases postoperative pain and prolongs the duration of local anaesthetic peripheral nerve blocks in studies including a limited number of patients.ObjectiveThe objective of this study is to evaluate the effect of combining dexamethasone with local anaesthetic on sensory and motor peripheral nerve blockade in adults.DesignA systematic review with meta-analysis of randomised controlled trials.Data SourcesWe systematically searched in Medline, Embase, Google Scholar and Cochrane Controlled Trials Register up to December 2013.Eligibility CriteriaRandomised trials testing dexamethasone combined with local anaesthetic.ResultsTwelve 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.ConclusionCombining dexamethasone with local anaesthetics results in a prolongation of the duration of peripheral nerve block.

This article appears in the collections: Does dexamethasone safely prolong peripheral nerve blocks?, Meta-analyses, and Dexamethasone for all sorts of things.

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