Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks. Issue 11 (November 2015)

• Record Type: Journal Article
• Authors: Huynh, Thi Mum; Marret, Emmanuel; Bonnet, Francis
• Is Part Of: European journal of anaesthesiology. Volume 32:Issue 11(2015:Nov.)
• Publication Date: 2015-11
• Subjects: Anesthesiology -- Periodicals; Anesthesiology -- Periodicals; Anesthésiologie -- Périodiques; Anesthesiology; Periodicals; Electronic journals; 617.96
• DOI: 10.1097/EJA.0000000000000248
• Languages: English
• ISSNs: 0265-0215

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND</title> <p>Dexamethasone decreases postoperative pain and prolongs the duration of local anaesthetic peripheral nerve blocks in studies including a limited number of patients.</p> </sec> <sec> <title>OBJECTIVE</title> <p>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.</p> </sec> <sec> <title>DESIGN</title> <p>A systematic review with meta-analysis of randomised controlled trials.</p> </sec> <sec> <title>DATA SOURCES</title> <p>We systematically searched in Medline, Embase, Google Scholar and Cochrane Controlled Trials Register up to December 2013.</p> </sec> <sec> <title>ELIGIBILITY CRITERIA</title> <p>Randomised trials testing dexamethasone combined with local anaesthetic.</p> </sec> <sec> <title>RESULTS</title> <p>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, <italic>P</italic> < 0.001] and motor blockade (WMD 277 min, 95% CI 167 to 387, <italic>P</italic> < 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.</p> </sec> <sec> <title>CONCLUSION</title> <p>Combining dexamethasone with local anaesthetics results in a prolongation of the duration of peripheral nerve block.</p> </sec> </abstract>