Does The Addition Of Dexamethasone To Local Anesthetic Used For Peripheral Nerve Block Prolong Analgesia In The Surgical Patient?

Pain after orthopedic surgery can be intense. Many anesthesia providers and orthopedic surgeons support the use of peripheral nerve blockade to assist in decreasing the amount of pain a patient may experience post operatively. Select medication adjuncts are being added to peripheral nerve blocks to prolong analgesia. The research presented here focuses on the addition of dexamethasone to peripheral nerve blocks to prolong analgesia. Dexamethasone is a synthetic glucocorticoid that acts as an anti-inflammatory. It has been shown to inhibit the release of inflammatory mediators such as, interleukins and cytokines, facilitating the release of anti-inflammatory mediators, decreasing postoperative pain. Recent evidence demonstrates a potential role of dexamethasone in postoperative pain management, both as a systemic analgesic and as an adjunct to local anesthetics for perineural use. A single preoperative dose of dexamethasone has been shown to be an effective adjunct to reduce postoperative pain and opioid consumption after surgery. This may be explained by various methods. When combined with local anesthetics, analgesia is prolonged either by inducing vasoconstriction and reducing the absorption of local anesthetic or by increasing the activity of inhibitory potassium channels on nociceptive c-fibers, decreasing their activity and prolonging sensory and motor blockade. There is need for further research on intravenous dexamethasone and perineural dexamethasone administration to determine if there is any difference in the length of post op analgesia when administered via these routes.