Titre
Comparison of intravenous versus perineural dexamethasone as a local anaesthetic adjunct for peripheral nerve blocks in the lower limb: A meta-analysis and systematic review.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Desai, N.
Auteure/Auteur
Pararajasingham, S.
Auteure/Auteur
Onwochei, D.
Auteure/Auteur
Albrecht, E.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1365-2346
Statut éditorial
Publié
Date de publication
2024-10-01
Volume
41
Numéro
10
Première page
749
Dernière page/numéro d’article
759
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Systematic Review ; Journal Article ; Meta-Analysis ; Comparative Study
Publication Status: ppublish
Publication Status: ppublish
Résumé
As a local anaesthetic adjunct, the systemic absorption of perineural dexamethasone in the lower limb could be restricted because of decreased vascularity when compared with the upper limb.
To compare the pharmacodynamic characteristics of intravenous and perineural dexamethasone in the lower limb.
Systematic review of randomised controlled trials with meta-analysis.
Systematic search of Central, Google Scholar, Ovid Embase and Ovid Medline to 18 July 2023.
Randomised controlled trials, which compared the intravenous with perineural administration of dexamethasone as a local anaesthetic adjunct in peripheral nerve blocks for surgery of the lower limb.
The most common peripheral nerve blocks were femoral, sciatic and ankle block. The local anaesthetic was long acting in all trials and the dose of dexamethasone was 8 mg in most trials. The primary outcome, the duration of analgesia, was investigated by all nine trials ( n = 546 patients). Overall, compared with intravenous dexamethasone, perineural dexamethasone increased the duration of analgesia from 19.54 to 22.27 h, a mean difference [95% confidence interval (CI) of 2.73 (1.07 to 4.38) h; P = 0.001, I2 = 87]. The quality of evidence was moderate owing to serious inconsistency. However, analysis based on the location of the peripheral nerve block, the type of local anaesthetic or the use of perineural adrenaline showed no difference in duration between intravenous and perineural dexamethasone. No differences were shown for any of the secondary outcomes related to efficacy and side effects.
In summary, moderate evidence supports the superiority of perineural dexamethasone over intravenous dexamethasone in prolonging the duration of analgesia. However, this difference is unlikely to be clinically relevant. Consideration of the perineural use of dexamethasone should recognise that this route of administration remains off label.
To compare the pharmacodynamic characteristics of intravenous and perineural dexamethasone in the lower limb.
Systematic review of randomised controlled trials with meta-analysis.
Systematic search of Central, Google Scholar, Ovid Embase and Ovid Medline to 18 July 2023.
Randomised controlled trials, which compared the intravenous with perineural administration of dexamethasone as a local anaesthetic adjunct in peripheral nerve blocks for surgery of the lower limb.
The most common peripheral nerve blocks were femoral, sciatic and ankle block. The local anaesthetic was long acting in all trials and the dose of dexamethasone was 8 mg in most trials. The primary outcome, the duration of analgesia, was investigated by all nine trials ( n = 546 patients). Overall, compared with intravenous dexamethasone, perineural dexamethasone increased the duration of analgesia from 19.54 to 22.27 h, a mean difference [95% confidence interval (CI) of 2.73 (1.07 to 4.38) h; P = 0.001, I2 = 87]. The quality of evidence was moderate owing to serious inconsistency. However, analysis based on the location of the peripheral nerve block, the type of local anaesthetic or the use of perineural adrenaline showed no difference in duration between intravenous and perineural dexamethasone. No differences were shown for any of the secondary outcomes related to efficacy and side effects.
In summary, moderate evidence supports the superiority of perineural dexamethasone over intravenous dexamethasone in prolonging the duration of analgesia. However, this difference is unlikely to be clinically relevant. Consideration of the perineural use of dexamethasone should recognise that this route of administration remains off label.
PID Serval
serval:BIB_446A59950B1F
PMID
Date de création
2024-07-12T12:21:31.820Z
Date de création dans IRIS
2025-05-20T16:31:38Z
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Nom
38988252_BIB_446A59950B1F.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by/4.0
Taille
1.38 MB
Format
Adobe PDF
PID Serval
serval:BIB_446A59950B1F.P001
URN
urn:nbn:ch:serval-BIB_446A59950B1F6
Somme de contrôle
(MD5):5675faeee5f9d6306b84c9de7f73b77b