A randomised controlled trial of perineural vs intravenous dexamethasone for foot surgery

• Published in: Anaesthesia 2016-03, Vol.71 (3), p.285-290
• Main Authors: Dawson, R. L., McLeod, D. H., Koerber, J. P., Plummer, J. L., Dracopoulos, G. C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Amides; Anesthesia; Anesthesia Recovery Period; Anesthetics, Local; Clinical trials; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Female; Foot - surgery; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Humans; Male; Middle Aged; Orthopedics; Pain, Postoperative - drug therapy; Sodium Chloride - administration & dosage; Surgery; Time Factors
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.13346

Summary We used 20 ml ropivacaine 0.75% for ankle blocks before foot surgery in 90 participants who we allocated in equal numbers to: perineural dexamethasone 8 mg and intravenous saline 0.9%; perineural saline 0.9% and intravenous dexamethasone 8 mg; or perineural and intravenous saline 0.9%. Dexamethasone increased the median (IQR [range]) time for the return of some sensation or movement, from 14.6 (10.8–18.8 [5.5–38.0]) h with saline to 24.1 (19.3–29.3 [5.0–44.0]) h when given perineurally, p = 0.00098, and to 20.9 (18.3–27.8 [8.8–31.3]) h when given intravenously, p = 0.0067. Dexamethasone increased the median (IQR [range]) time for the return of normal neurology, from 17.6 (14.0–21.0 [9.5–40.5]) h with saline to 27.5 (22.0–36.3 [7.0–53.0]) h when given perineurally, p = 0.00016, and to 24.0 (20.5–32.3 [13.0–42.5]) h when given intravenously, p = 0.0022. Dexamethasone did not affect the rates of block success, postoperative pain scores, analgesic use, or nausea and vomiting. The route of dexamethasone administration did not alter its effects.