STH Breakfast Club: Perineural dexamethasone in peripheral nerve blocks

April 19th, 2017. Jake Drinkwater

A copy of the full presentation is available at the following link (Perineural Dexamethasone), with a summary shown below.


Additives to local anaesthetic (LA) have long been used in an attempt to prolong the duration, reduce the onset time and improve the safety profile of LA’s. Recently there has been much interest in the addition of dexamethasone to LA used for peripheral nerve blockade with the aim of prolonging the duration of the block. As with any new technique there are often undesirable consequences, side effects and often a degree of risk. As ever, the clinical benefit of the technique must be weighed against the risks and against alternative techniques. In this presentation we look at the current evidence for the use of Dexamethasone to prolong to duration of peripheral nerve blockade.

Main question/ issues discussed:

  1. Does dexamethasone increase duration analgesia of nerve blocks?
  2. Is perineural dexamethasone better than systemic administration?
  3. Is perineural dexamethasone safe?

Take home messages:

Perineural dexamethasone significantly prolongs the duration of peripheral nerve blocks, with greater effect when added to longer acting local anaesthetics. However, a statistically similar prolongation of the duration of peripheral nerve blocks can be achieved with systemically administered dexamethasone. Owing to uncertainty regarding the neurotoxic effects of dexamethasone and in the absence of a clear benefit of perineural administration, current evidence points towards the systemic administration to prolong the duration of peripheral nerve blockade.


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  2. Abdallah FW, Johnson J, Chan V, Murgatroyd H, Ghafari M, Ami N, et al. Intravenous Dexamethasone and Perineural Dexamethasone Similarly Prolong the Duration of Analgesia After Supraclavicular Brachial Plexus Block. Regional Anesthesia and Pain Medicine. 2015;40(2):125–32.
  3. Albrecht E, Kern C, Kirkham KR. Perineural vs intravenous administration of dexamethasone: more data are available. British Journal of Anaesthesia. 2014 Dec 11;114(1):160–0.
  4. Aliste J, Leurcharusmee P, Engsusophon P, Gordon A, Michelagnoli G, Sriparkdee C, et al. Comparaison randomisée entre la dexaméthasone intraveineuse et périneurale pour réaliser un bloc axillaire échoguidé. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2016 Sep 23;64(1):29–36.
  5. Bjørn S, Linde F, Nielsen KK, Børglum J, Hauritz RW, Bendtsen TF. Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery. Regional Anesthesia and Pain Medicine. 2017;42(2):210–6.
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  8. Chun EH, Kim YJ, Woo JH. Which is your choice for prolonging the analgesic duration of single-shot interscalene brachial blocks for arthroscopic shoulder surgery? intravenous dexamethasone 5 mg vs. perineural dexamethasone 5 mg randomized, controlled, clinical trial. Medicine. 2016 Jun;95(23):e3828–8.
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STH Consultant CPD Updates: Pain

This is the summary of the PowerPoint presentations from this month’s  consultant CPD teaching programme.

This month’s session provided an update on pain management in line with the Royal College of Anaesthetists Matrix.

The following areas were covered by Dr Nick Plunkett, Dr Rob Atcheson and Dr Ravi Parekodi (all Consultant Anaesthetists, Sheffield Teaching Hospitals NHS Foundation Trust). Please click the link for a copy of the presentation.