Intravenous dexamethasone and peripheral nerve blocks: A systemic review and meta-analysis of randomized controlled trials

ABSTRACT Background: Poorly managed postoperative pain may delay discharge and recovery, lowers the quality of life, and it may result in chronic pain. Intravenous (IV) dexamethasone has been used as an additive to local anesthetic for peripheral nerve blocks (PNBs) with variable efficacy. The aim of this Systemic review and meta-analysis is to assess the effectiveness of IV dexamethasone as an adjuvant to local anesthetic for PNBs. Methods: The PRISMA statement guideline is followed to conduct this SR and MA. The primary outcome was the duration of analgesia analyzed according to a dose of dexamethasone (4, 8, and 10 mg). Secondary outcomes included duration of sensory block, duration of motor block, postoperative opioid consumption, pain severity score, patient satisfaction, and incidence of PONV. Eleven randomized controlled trials, including 709 patients, were included. Results: The duration of analgesia was significantly prolonged with IV dexamethasone with a mean difference of 5.04 h CI, 2.65 to 7.44; I2 = 100%, P < 0.0001 compared to control. Sub-group analysis found IV dexamethasone 4 mg and 8 mg did not show a significant difference in prolonging analgesia duration (P = 0.11). However, IV dexamethasone 10 mg significantly prolonged analgesic duration of PNBs when compared to control with P < 0.00001. Regarding secondary outcomes IV dexamethasone increased duration of sensory block, decrease postoperative pain severity, and opioids consumption at 24 h. Conclusions: IV dexamethasone as an additive to PNBs could increase duration analgesia, sensory block and decreases postoperative pain severity, opioids consumption, and sleep disturbance of first night after surgery. Highlights: