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DOES DEXAMETHASONE HAVE A PERINEURAL MECHANISM OF ACTION? A PAIRED, BLINDED, RANDOMISED, CONTROLLED STUDY IN HEALTHY VOLUNTEERS
ESRA Academy. Jæger P. Sep 8, 2016; 138426
Topic: Adjuvant Drugs
Disclosure(s): The authors gratefully thank the ESRA Research Grant for providing funding for the study
Dr. Pia Jæger
Dr. Pia Jæger

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Abstract
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Background and Aims:

Dexamethasone prolongs block duration. Whether this is achieved via a peripheral or central mechanism of action is unknown. We hypothesized that perineural dexamethasone added as an adjuvant to ropivacaine prolongs block duration compared with ropivacaine alone, by a locally mediated effect when controlled for a systemic action.

Methods:

We performed a paired, blinded, randomised trial, including healthy men. All subjects received bilateral blocks of the saphenous nerve with 20 ml ropivacaine 0.5%, mixed with 2 mg dexamethasone in one leg and saline in the other (ensuring identical systemic effects). The  outcome measures were duration of sensory block in the saphenous nerve distribution assessed by temperature discrimination (primary outcome),  mechanical discrimination, pain response to tonic heat stimulation, warmth and heat pain detection thresholds (secondary outcomes). Ethics Committee Approval: H-3-2014-145.

Results:

We included 20 subjects; one had a failed block and was excluded from the paired analysis. Block duration was not statistically significantly longer in the leg receiving dexamethasone when assessed by temperature discrimination (primary outcome, estimated median difference 1.5 h, 95% CI 0 to 3.5). For all other outcomes duration was statistically significantly longer in the leg receiving dexamethasone, but the median differences were ≤2.5 h. Individual subject analysis revealed that only eight subjects had a block prolongation of at least two hours in the leg receiving dexamethasone perineurally.

Conclusions:

Perineural administration of 2 mg of dexamethasone showed a modest and inconsistent effect of questionable clinical relevance on block duration, but a systemic action cannot be suspended.

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