Efficacy of perineural dexamethasone in prolonging duration of analgesia with peripheral nerve blocks compared to intravenous dexamethasone: A systematic review and meta-analysis

A comparative evaluation of the effect of addition of 8 mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study

Background

Impacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially.

Aim

To evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars.

Methodology

A controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures.

Results

Test group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p < 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p < 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p < 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7.

Conclusion

The addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.

Dexamethasone Plus Bupivacaine Versus Bupivacaine in Bilateral Transincisional Paravertebral Block in Lumbar Spine Surgeries: A Randomized Controlled Trial

OBJECTIVES

Few studies examined the analgesic effects of dexamethasone in lumbar paravertebral block, specifically the transincisional approach. This study aimed to compare dexamethasone with bupivacaine versus bupivacaine alone for bilateral transincisional paravertebral block (TiPVB) for postoperative analgesia in lumbar spine surgeries.

MATERIALS AND METHODS

Fifty patients who were aged 20 to 60 years and had American Society of Anesthesiologists Physical Status (ASA-PS) I or II of either sex were randomly allocated into 2 equal groups. Both groups received combined general anesthesia and bilateral lumbar TiPVB. However, in group 1 (dexamethasone group) (n=25), patients received 14 mL of bupivacaine 0.20% plus 1 mL containing 4 mg of dexamethasone on each side, while, in group 2 (control group) (n=25), patients received 14 mL of bupivacaine 0.20% plus 1 mL of saline on each side. Time to first analgesic need was the primary outcome, while total opioid consumption during the first 24 hours after surgery, the Visual Analog Scale for pain perception (0-10), and the incidence of side effects were secondary outcomes.

RESULTS

The mean time to the first analgesic requirement was significantly prolonged among patients in the dexamethasone group than the control group (mean±SD: 18.4±0.8 vs. 8.7±1.2 h, respectively) ( P <0.001). Patients in the dexamethasone group had lower total opiates consumption than the control) P <0.001). Although nonsignificant, the incidence of postoperative nausea and vomiting was more frequent among the control group ( P =0.145).

DISCUSSION

Adding dexamethasone to bupivacaine in TiPVB resulted in a prolonged analgesia-free period and lower opioid consumption in lumbar spine surgeries with comparable incidence of adverse events.

[Rebound pain-From definition to treatment]

Hintergrund

Rebound pain als Nebenwirkung einer Regionalanästhesie ist ein übermäßiges Schmerzempfinden nach Abklingen der Wirkung der lokalen Betäubung, welches deutlich über den normalen Wundschmerz nach einer Operation hinausgeht. Dieses Phänomen rückt seit ca. 10 Jahren stärker in den Fokus der Forschung. Die konkreten Ursachen sind bisher unklar, und es existieren auch noch keine zielgerichteten Therapieempfehlungen.

Ziel der Arbeit

Dieser Übersichtsartikel soll der Leserschaft einen Überblick über den aktuellen Stand der Forschung geben. Es werden die Theorien zur Pathophysiologie vorgestellt und Prophylaxe- sowie Behandlungsstrategien erläutert.

Material und Methoden

Für diese Übersichtsarbeit wurden die von 2005 bis Mai 2021 auf PubMed erschienenen Publikationen zum Thema Rebound pain durchgesehen und die Definitionen der Autoren zu Rebound pain sowie die Annahmen zur Pathophysiologie und Therapieempfehlungen zusammengefasst.

Ergebnisse und Diskussion

Insgesamt wurden 22 Originalarbeiten im Hinblick auf die Definition von Rebound pain, die Annahme der Entstehung sowie Therapieoptionen ausgewertet. Dabei zeigt sich, dass keine einheitliche Definition existiert, die Pathophysiologie nicht eindeutig geklärt ist und zum aktuellen Zeitpunkt auch noch keine klaren Empfehlungen zu Prophylaxe sowie Therapie gegeben werden können.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00101-022-01120-z) enthält eine tabellarische Zusammenstellung über Studiendesign sowie Kernaussagen der vorgestellten Studien.