Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis
Perineural dexamethasone has gained popularity in regional anaesthesia to prolong the duration of analgesia, but its advantage over systemic administration is disputed. The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2017-08, Vol.119 (2), p.183-191 |
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| creator | Baeriswyl, M. Kirkham, K.R. Jacot-Guillarmod, A. Albrecht, E. |
| description | Perineural dexamethasone has gained popularity in regional anaesthesia to prolong the duration of analgesia, but its advantage over systemic administration is disputed. The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve block. The methodology followed the PRISMA statement guidelines. The primary outcome was the duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in morphine i.v. equivalents, pain scores, and complication rates (neurological complications, infection, or hyperglycaemia). Eleven controlled trials, including 914 patients, were identified. The duration of analgesia was significantly increased with perineural dexamethasone vs systemic dexamethasone by a mean difference of 3 h [95% confidence interval (CI): 1.4, 4.5 h; P=0.0001]. Subgroup analysis revealed that the duration of analgesia was increased by 21% with bupivacaine (mean difference: 4.0 h; 95% CI: 2.8, 5.2 h; P |
| doi_str_mv | 10.1093/bja/aex191 |
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The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve block. The methodology followed the PRISMA statement guidelines. The primary outcome was the duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in morphine i.v. equivalents, pain scores, and complication rates (neurological complications, infection, or hyperglycaemia). Eleven controlled trials, including 914 patients, were identified. The duration of analgesia was significantly increased with perineural dexamethasone vs systemic dexamethasone by a mean difference of 3 h [95% confidence interval (CI): 1.4, 4.5 h; P=0.0001]. Subgroup analysis revealed that the duration of analgesia was increased by 21% with bupivacaine (mean difference: 4.0 h; 95% CI: 2.8, 5.2 h; P<0.00001) and 12% with ropivacaine (mean difference: 2.0 h; 95% CI: −0.5, 4.5 h; P=0.11). The quality of evidence for our primary outcome was moderate according to the GRADE system. There were no significant differences in other secondary outcomes. No neurological complications or infections were reported. Glucose concentrations were not increased when dexamethasone was injected systemically, but this outcome was reported by only two trials. There is, therefore, moderate evidence that perineural dexamethasone combined with bupivacaine, but not ropivacaine, slightly prolongs the duration of analgesia, without an impact on other pain-related outcomes, when compared with systemic dexamethasone. 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For Permissions, please email: journals.permissions@oup.com 2017</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-d09f85095d09b278643d324dd81acc90f6e06c5a3d2476e1402db655a30b6fa33</citedby><cites>FETCH-LOGICAL-c464t-d09f85095d09b278643d324dd81acc90f6e06c5a3d2476e1402db655a30b6fa33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28854551$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baeriswyl, M.</creatorcontrib><creatorcontrib>Kirkham, K.R.</creatorcontrib><creatorcontrib>Jacot-Guillarmod, A.</creatorcontrib><creatorcontrib>Albrecht, E.</creatorcontrib><title>Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Perineural dexamethasone has gained popularity in regional anaesthesia to prolong the duration of analgesia, but its advantage over systemic administration is disputed. The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve block. The methodology followed the PRISMA statement guidelines. The primary outcome was the duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in morphine i.v. equivalents, pain scores, and complication rates (neurological complications, infection, or hyperglycaemia). Eleven controlled trials, including 914 patients, were identified. The duration of analgesia was significantly increased with perineural dexamethasone vs systemic dexamethasone by a mean difference of 3 h [95% confidence interval (CI): 1.4, 4.5 h; P=0.0001]. Subgroup analysis revealed that the duration of analgesia was increased by 21% with bupivacaine (mean difference: 4.0 h; 95% CI: 2.8, 5.2 h; P<0.00001) and 12% with ropivacaine (mean difference: 2.0 h; 95% CI: −0.5, 4.5 h; P=0.11). The quality of evidence for our primary outcome was moderate according to the GRADE system. There were no significant differences in other secondary outcomes. No neurological complications or infections were reported. Glucose concentrations were not increased when dexamethasone was injected systemically, but this outcome was reported by only two trials. There is, therefore, moderate evidence that perineural dexamethasone combined with bupivacaine, but not ropivacaine, slightly prolongs the duration of analgesia, without an impact on other pain-related outcomes, when compared with systemic dexamethasone. Injection of perineural dexamethasone should be cautiously balanced in light of the off-label indication for this route of administration.</description><subject>Analgesia</subject><subject>anesthetics, local</subject><subject>Blood Glucose - analysis</subject><subject>Bupivacaine - administration & dosage</subject><subject>dexamethasone</subject><subject>Dexamethasone - administration & dosage</subject><subject>Humans</subject><subject>nerve block</subject><subject>Nerve Block - methods</subject><subject>pain, postoperative</subject><subject>Pain, Postoperative - prevention & control</subject><subject>Time Factors</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFu1DAURS1ERYfChg9A3iBVSGntxHYSdqgqtFKlbmBtvdjPrUsSBzsZOp_Qv66HDKwQK1vWuUfyIeQdZ2ectdV59wDngI-85S_IhouaF6qu-UuyYYzVBWt5eUxep_TAGK_LVr4ix2XTSCEl35CnS-e8AbOjwdEJox9xidDTbaJpl2YcvKEWH2HA-R5SGJHOgU4x9GG8ozBCf4fJAwU3Y_y9n-5xvx8xbpF2fTA_PlE4uGDOtohbj7_y1tIshWIv2SWf3pAjB33Ct4fzhHz_cvnt4qq4uf16ffH5pjBCibmwrHWNZK3Ml66sGyUqW5XC2oaDMS1zCpkyEipbilohF6y0nZL5gXXKQVWdkNPVm3_xc8E068Eng30PI4Ylad5WomxUJffoxxU1MaQU0ekp-gHiTnOm9-l1Tq_X9Bl-f_Au3YD2L_qndQY-rEBYpv-LxMphrpBbRZ2Mx9Gg9RHNrG3w_5o9A13QoYA</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Baeriswyl, M.</creator><creator>Kirkham, K.R.</creator><creator>Jacot-Guillarmod, A.</creator><creator>Albrecht, E.</creator><general>Elsevier Ltd</general><general>Oxford University Press</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201708</creationdate><title>Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis</title><author>Baeriswyl, M. ; Kirkham, K.R. ; Jacot-Guillarmod, A. ; Albrecht, E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-d09f85095d09b278643d324dd81acc90f6e06c5a3d2476e1402db655a30b6fa33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Analgesia</topic><topic>anesthetics, local</topic><topic>Blood Glucose - analysis</topic><topic>Bupivacaine - administration & dosage</topic><topic>dexamethasone</topic><topic>Dexamethasone - administration & dosage</topic><topic>Humans</topic><topic>nerve block</topic><topic>Nerve Block - methods</topic><topic>pain, postoperative</topic><topic>Pain, Postoperative - prevention & control</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baeriswyl, M.</creatorcontrib><creatorcontrib>Kirkham, K.R.</creatorcontrib><creatorcontrib>Jacot-Guillarmod, A.</creatorcontrib><creatorcontrib>Albrecht, E.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baeriswyl, M.</au><au>Kirkham, K.R.</au><au>Jacot-Guillarmod, A.</au><au>Albrecht, E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2017-08</date><risdate>2017</risdate><volume>119</volume><issue>2</issue><spage>183</spage><epage>191</epage><pages>183-191</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>Perineural dexamethasone has gained popularity in regional anaesthesia to prolong the duration of analgesia, but its advantage over systemic administration is disputed. The objective of this meta-analysis was to compare the analgesic efficacy of both routes of administration during peripheral nerve block. The methodology followed the PRISMA statement guidelines. The primary outcome was the duration of analgesia analysed according to the type of local anaesthetic administered (bupivacaine or ropivacaine). Secondary outcomes included cumulative opioid consumption in morphine i.v. equivalents, pain scores, and complication rates (neurological complications, infection, or hyperglycaemia). Eleven controlled trials, including 914 patients, were identified. The duration of analgesia was significantly increased with perineural dexamethasone vs systemic dexamethasone by a mean difference of 3 h [95% confidence interval (CI): 1.4, 4.5 h; P=0.0001]. Subgroup analysis revealed that the duration of analgesia was increased by 21% with bupivacaine (mean difference: 4.0 h; 95% CI: 2.8, 5.2 h; P<0.00001) and 12% with ropivacaine (mean difference: 2.0 h; 95% CI: −0.5, 4.5 h; P=0.11). The quality of evidence for our primary outcome was moderate according to the GRADE system. There were no significant differences in other secondary outcomes. No neurological complications or infections were reported. Glucose concentrations were not increased when dexamethasone was injected systemically, but this outcome was reported by only two trials. There is, therefore, moderate evidence that perineural dexamethasone combined with bupivacaine, but not ropivacaine, slightly prolongs the duration of analgesia, without an impact on other pain-related outcomes, when compared with systemic dexamethasone. 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| subjects | Analgesia anesthetics, local Blood Glucose - analysis Bupivacaine - administration & dosage dexamethasone Dexamethasone - administration & dosage Humans nerve block Nerve Block - methods pain, postoperative Pain, Postoperative - prevention & control Time Factors |
| title | Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis |
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