ESRA Academy. Lima G. Sep 8, 2016; 138579
Gisela Lima
Gisela Lima

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Background and Aims:

Dexamethasone has been extensively used in the perioperative seeting such it provides analgesia and reduces nausea and vomiting (PONV). Its use as an adjuvant in regional anesthesia is receiving increasing interest. We discuss the clinical utlity of intravenous (IV) dexamethasone in spinal anaesthesia.


Systematic review carried out in Pubmed using the MeSH terms: anesthesia, spinal; dexamethasone; anesthesia; analgesia. The most significant milestones were noted down in the order of their first publication. Only randomized, double-blinded, placebo-controlled studies were included.


Several studies evaluate IV dexamethasone effects in pain control, spinal blocks duration and postoperative nausea and vomiting. We found conflicting data. In one study a single dose of dexamethasone 40 mg IV resulted in less dynamic pain at 24 hours and lower C-reactive protein levels after total hip arthroplasty under spinal anaesthesia. Other study revealed enhanced analgesia and reduced PONV with intrathecal meperidine and IV dexamethasone (0.1 mg/kg). However profilactic IV dexamethasone administration did not enhance analgesia or reduced the incidence of emesis in patients receiving spinal anaesthesia with tetracaine plus neostigmine during inguinal herniorraphy. 

In peripheral nerve blocks, the 95% effective dose of dexamethasone for analgesia may be 0.1 mg/kg or higher.


Additional studies need to be conducted to clarify the effects of IV dexamethasone as an adjunct in spinal anaesthesia. At least some of the diferences of these studies results may be due to the different doses administered.

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