Dose–response relationships of intravenous and perineural dexamethasone as adjuvants to peripheral nerve blocks: a systematic review and model-based network meta-analysis
Authors' conclusion
Used as an adjuvant for peripheral nerve block, intravenous dexamethasone can be as effective as perineural dexamethasone in prolonging analgesic duration, but is less potent, hence requiring higher doses.
Study context
- Population
- Adults receiving unilateral peripheral nerve blocks
- Participants
- 9,284 adults · 118 studies
- Comparison
- Perineural vs IV dexamethasone as adjuvant to peripheral nerve blocks
- Perineural dexamethasonen = 106
- Intravenous dexamethasonen = 35reference
- Outcome
- Duration of nerve block analgesia (dose-response)
Methodological detailsmaximum effect (Emax) model, Cochrane Risk-of-Bias tool, trial simulations
- Maximum effect (Emax) model
- Cochrane Risk-of-Bias tool
- Trial simulations
Pooled result
As reported in the abstract
Maximum fold increase in analgesia duration with dexamethasone (bias-corrected)
Maximum fold increase in analgesia duration, 95% CrI 1.4-1.9
1.7
Further pooled results
Mean duration of analgesia, long-acting local anaesthetics (trial simulation, 4 mg perineural dexamethasone)
- Without dexamethasone, h
- 11.1 (95% CrI 9.4-13.1)
- With 4 mg perineural dexamethasone, h
- 16.5 (95% CrI 14.0-19.3)
- Similar magnitude of effect with 8 mg IV dexamethasone
- Trial simulations
PONV (trial simulation, 4 mg perineural dexamethasone)
- Rate of PONV halved
- Trial simulations
Risk of bias
- Studies with unclear or high risk of bias overestimated the effect of dexamethasone
Original publication
Dose–response relationships of intravenous and perineural dexamethasone as adjuvants to peripheral nerve blocks: a systematic review and model-based network meta-analysis. Br J Anaesth. Published 27 January 2024. doi:10.
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