Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis

  • Nasir Hussain
  • Tom Van den Langenbergh
  • Corey Sermer
  • Manuel L. Fontes
  • Amit Atrey
  • Naum Shaparin
  • Tamara R. Sawyer
  • Amaresh Vydyanathan
Review Article/Brief Review
First Online:
Received:
Accepted:

Abstract

Purpose

Dexamethasone is commonly used as an adjuvant to local anesthetics for peripheral nerve blockade; however, uncertainty persists regarding its optimal route of administration and safety. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare the incremental benefits of intravenous (IV) vs perineural (PN) dexamethasone when used as adjuvants for peripheral nerve blockade to improve analgesia.

Sources

A search strategy was developed to identify eligible articles from the Cochrane and National Library of Medicine databases from inception until June 2017. The National Center for Biotechnology Information Medical Subject Headings browser thesaurus was used to identify search terms and combinations of keywords. Any clinical trial that randomly allocated adult patients (≥ 18 yr old) to receive either IV or PN dexamethasone for peripheral nerve blockade was considered for inclusion.

Principal findings

After full-text screening of potentially eligible articles, 14 RCTs were included in this review. Overall, the use of PN dexamethasone did not provide a significant incremental benefit to the duration of analgesia [ratio of means (ROM), 1.23; Hartung-Knapp-Sidik-Jonkman (HKSJ) 95% confidence interval (CI), 0.85 to 1.85; P = 0.23] or to motor block duration (ROM, 1.14; HKSJ 95% CI, 0.98 to 1.31; P = 0.07). Also, at 24-hr follow-up, there was no significant difference between the two groups regarding pain scores (standardized mean difference, 0.36; HKSJ 95% CI, -0.08 to 0.80; I2 = 75%; P = 0.09) and cumulative opioid consumption (mean difference, 5.23 mg; HKSJ 95% CI, -4.60 to 15.06; P = 0.15). Lastly, no long-term nerve-related complications were observed with the use of PN dexamethasone.

Conclusions

The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade.

Équivalence de l’efficacité analgésique entre la dexaméthasone administrée par voie périnerveuse vs intraveineuse en tant qu’adjuvant à un bloc du nerf périphérique : revue systématique et méta-analyse

Résumé

Objectif

La dexaméthasone est fréquemment utilisée comme adjuvant aux anesthésiques locaux pour compléter les blocs nerveux périphériques; toutefois, sa voie d’administration optimale et son innocuité demeurent inconnues. Une revue systématique et une méta-analyse des études randomisées contrôlées (ERC) ont été réalisées afin de comparer les avantages distinctifs de la dexaméthasone administrée par voie intraveineuse (IV) vs périnerveuse (PN) lorsque ces modalités sont utilisées comme adjuvants à un bloc nerveux périphérique pour améliorer l’analgésie.

Source

Une stratégie de recherche a été mise au point afin d’identifier les articles éligibles dans les bases de données Cochrane et de la National Library of Medicine depuis leur création et jusqu’au mois de juin 2017. Le thésaurus du navigateur de descripteurs médicaux (termes MeSH) du Centre national pour les renseignements biotechnologiques américain (National Center for Biotechnology Information) a été utilisé afin d’identifier les termes de recherche et les combinaisons de mots-clés. Le critère d’inclusion de notre étude était tout essai clinique ayant alloué aléatoirement des patients adultes (âgés de 18 ans ou plus) à recevoir de la dexaméthasone IV ou PN pour un bloc nerveux périphérique.

Constatations principales

Après une lecture du texte intégral des articles potentiellement éligibles, 14 ERC ont été incluses dans cette revue. Globalement, l’utilisation de dexaméthasone PN n’a pas procuré d’avantage supplémentaire significatif en matière de durée de l’analgésie [rapport de moyennes (RM), 1,23; intervalle de confiance (IC) 95 % de Hartung-Knapp-Sidik-Jonkman (HKSJ), 0,85 à 1,85; P = 0,23] ou de durée du bloc moteur (RM, 1,14; IC 95 % HKSJ, 0,98 à 1,31; P = 0,07). En outre, au suivi de 24 h, il n’y avait aucune différence significative entre les deux groupes en matière de scores de douleur (différence moyenne standardisée, 0,36; IC 95 % HKSJ, -0,08 à 0,80; I2 = 75 %; P = 0,09) et de consommation d’opioïdes cumulée (différence moyenne, 5,23 mg; IC 95 % HKSJ, -4,60 à 15,06; P = 0,15). Enfin, aucune complication neurologique n’a été observée à long terme avec l’utilisation de dexaméthasone PN.

Conclusion

Les résultats de notre méta-analyse suggèrent que la dexaméthasone PN et IV procurent des bienfaits analgésiques équivalents et affichent des profils d’innocuité semblables lors de leur utilisation pour un bloc nerveux périphérique.

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Notes

Acknowledgements

We sincerely thank all the corresponding authors who graciously provided us with their data for this meta-analysis. The authors also thank Aamir Ahmed for his contributions to the manuscript.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Steven Backman, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Nasir Hussain and Amaresh Vydyanathan were involved in concept development. Nasir Hussain, Tom Van den Langenbergh, Corey Sermer, Manuel L Fontes, Amit Atrey, Naum Shaparin, and Amaresh Vydyanathan were involved in manuscript preparation. Nasir Hussain, Tom Van den Langenbergh, Corey Sermer, and Tamara R. Sawyer were involved in methods development. Nasir Hussain was involved in data collection and statistical analyses.

Financial support and sponsorship

None.

Supplementary material

12630_2017_1008_MOESM1_ESM.pdf (39 kb)
Supplementary material 1 (PDF 38 kb)
12630_2017_1008_MOESM2_ESM.docx (128 kb)
Supplementary material 2 (DOCX 128 kb)
12630_2017_1008_MOESM3_ESM.pdf (44 kb)
Supplementary material 3 (PDF 44 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2017

Authors and Affiliations

  1. 1.Central Michigan University College of MedicineMt. PleasantUSA
  2. 2.West Suffolk NHS Foundation TrustSuffolkEngland
  3. 3.Faculty of MedicineUniversity of TorontoTorontoCanada
  4. 4.Department of AnesthesiologyYale School of MedicineNew HavenUSA
  5. 5.Department of OrthopaedicsSt. Michael’s HospitalTorontoCanada
  6. 6.Department of AnesthesiaMontefiore Medical CenterBronxUSA

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