The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: a randomized, double-blind, placebo-controlled study.

نویسندگان

  • Rohit Rahangdale
  • Mark C Kendall
  • Robert J McCarthy
  • Luminita Tureanu
  • Robert Doty
  • Adam Weingart
  • Gildasio S De Oliveira
چکیده

BACKGROUND Perineural dexamethasone has been investigated as an adjuvant for brachial plexus nerve blocks, but it is not known whether the beneficial effect of perineural dexamethasone on analgesia duration leads to a better quality of surgical recovery. We hypothesized that patients receiving dexamethasone would have a better quality of recovery than patients not receiving dexamethasone. We also sought to compare the effect of perineural with that of IV dexamethasone on block characteristics. METHODS Patients undergoing elective ankle and foot surgery were recruited over a 9-month period. Patients received ultrasound-guided sciatic nerve blocks by using 0.5% bupivacaine with epinephrine 1:300,000 (0.45 mL/kg) and were randomized into 3 groups: group 1 = perineural dexamethasone 8 mg/2 mL with 50 mL IV normal saline, group 2 = perineural saline/2 mL with IV 8 mg dexamethasone in 50 mL normal saline, and group 3 = perineural saline/2 mL with 50 mL normal saline. The primary outcome was the global score in the quality of recovery (QoR-40). The secondary outcomes included analgesia duration, opioid consumption, patient satisfaction, numeric pain rating scores, and postoperative neurologic symptoms. RESULTS Eighty patients were randomized, and 78 patients completed the study protocol. There was no improvement in the global QoR-40 score at 24 hours between the perineural dexamethasone and saline, median (97.5% CI) difference of -3 (-7 to 3); IV dexamethasone and saline, median difference of -1 (-8 to 5); or perineural dexamethasone and IV dexamethasone median difference of -2 (-6 to 5). Analgesia duration (P < 0.001) and time to first toe movement (P < 0.001) were prolonged by perineural dexamethasone compared with saline. IV dexamethasone prolonged time to first toe movement compared with saline (P = 0.008) but not analgesia duration (P = 0.18). There was no significant difference in the time to first toe movement or analgesia duration between the perineural and IV dexamethasone groups. Postoperative opioid consumption was not different among study groups. Self-reported neurologic symptoms at 24 hours were not different among perineural dexamethasone (17, 63%), IV dexamethasone (10, 42%), or normal saline (8, 30%) (P = 0.31). All postoperative neurologic sequelae were resolved by 8 weeks. CONCLUSIONS Preoperative administration of IV and perineural dexamethasone compared with saline did not improve overall QoR-40 or decrease opioid consumption but did prolong analgesic duration in patients undergoing elective foot and ankle surgery and receiving sciatic nerve block. Given the lack of clinical benefit and the concern of dexamethasone neurotoxicity as demonstrated in animal studies, the practice of perineural dexamethasone administration needs to be further evaluated.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Analgesic Efficacy of Intravenous Lidocaine Infusion in Cesarean Section under Spinal Anesthesia: A Prospective Randomized Double-Blind Study

Background & Objective: Nowadays, conventional analgesic agents that are usually used for pain killing after cesarean sections do not provide enough analgesia with infrequent serious side effects. Lidocaine has been suggested as an adjuvant analgesic agent for postoperative pain relief. We designed this randomized double-blind, placebo-controlled study to evaluate the analgesic efficacy of intr...

متن کامل

Perineural versus intravenous dexamethasone as an adjuvant in regional anesthesia: a systematic review and meta-analysis

BACKGROUND Dexamethasone is a common adjuvant for local anesthetics in regional anesthesia, but the optimal route of administration is controversial. Therefore, we did a systematic review and meta-analysis of randomized controlled trials to assess the effect of perineural versus intravenous dexamethasone on local anesthetic regional nerve-blockade outcomes. MATERIALS AND METHODS Medline (thro...

متن کامل

A PROSPECTIV E, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL OF DEXAMETHASONE DURING THE FOLLICULAR PHASE IN CLOMIPHENE RESISTANT PATIENTS WITH POLYCYSTIC OVARY SYNDROME AND NORMAL DHEAS

In order to evaluate the effects of short course administration of dexamethasone (DEX) combined with clomiphene citrate (CC) in CC-resistant patients with polycystic ovary syndrome (PCaS) and normal DHEAS, a prospective, double blind, placebo controlled, randomized study was undertaken at referral university hospitals, Two-hundred and thirty women with PCOS and normal DHEAS who failed to ...

متن کامل

Comparing the Prophylactic Effect of Pregabalin with that of Aminophylline Plus Dexamethasone on Postdural Puncture Headache after Spinal Anesthesia in Cesarean Section: A Double-Blind Controlled Randomized Clinical Trial

Background: Headache is yet considered an undesirable complication of spinal anesthesia as a selective method in cesarean section. The present study was conducted to compare the prophylactic effect of pregabalin with that of aminophylline plus dexamethasone on postdural puncture headache after spinal anesthesia in cesarean section. Materials and Methods: The present double-blind controlled rand...

متن کامل

Which is your choice for prolonging the analgesic duration of single-shot interscalene brachial blocks for arthroscopic shoulder surgery? intravenous dexamethasone 5 mg vs. perineural dexamethasone 5 mg randomized, controlled, clinical trial

The aim of this study was to compare the effect of intravenous (I.V.) dexamethasone with that of perineural dexamethasone on the prolongation of analgesic duration of single-shot interscalene brachial plexus blocks (SISB) in patients undergoing arthroscopic shoulder surgery. We performed a prospective, randomized, double-blind, placebo-controlled study. Patients undergoing elective arthroscopic...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Anesthesia and analgesia

دوره 118 5  شماره 

صفحات  -

تاریخ انتشار 2014