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DOES PERINEURAL DEXAMETHASONE PROLONG THE DURATION OF THE SUBSARTORIAL SAPHENOUS NERVE BLOCK AND IMPROVE POSTOPERATIVE ANALGESIA AFTER MAJOR ANKLE SURGERY? A RANDOMIZED, TRIPLE-BLIND, PLACEBO-CONTROLLED TRIAL
ESRA Academy. Bjørn S. Sep 8, 2016; 138286
Topic: Peripheral Nerve Blocks
Siska Bjørn
Siska Bjørn

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Abstract
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Background and Aims:

Patients undergoing major ankle surgery often complain of pain from the anteromedial side of the ankle despite effective sciatic analgesia. The pain originates from the saphenous nerve territory and typically persists beyond the duration of a single-injection saphenous nerve block. Our aim was to investigate whether perineural dexamethasone as an adjuvant for the saphenous nerve block would prolong the duration of analgesia as well as postpone and reduce opioid requiring pain.

Methods:

Forty patients were included in this prospective, triple-blind, placebo-controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous block with 10 mL 0.5% bupivacaine c. epinephrine with addition of 1 mL saline or 1 mL 0.4% (i.e. 4 mg) dexamethasone. The primary outcome was time until the first opioid-requiring pain. Secondary outcome measures were pain, opioid consumption and thermanalgesia the first 48 postoperative hours.

Results:

The mean (SD) duration of the saphenous nerve block was 29.7 (8.5) hours in the dexamethasone group and 21.9 (9.9) hours in the control group (P = 0.019). The mean opioid consumption (SD) during the first 24 hours was 2.1 mg (4.4) vs. 14.9 mg (20.6) in the dexamethasone and control groups, respectively. Non-parametric comparison of opioid consumption 0-24 hours was statistically significant (P = 0.013). Opioid consumption from 24-48 hours and pain scores did not differ significantly between groups. 





Conclusions:

Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong duration and improve postoperative analgesia after major ankle surgery.

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