Rebound Pain and Patient Satisfaction With Dexamethasone as an Adjunct for Peripheral Nerve Blocks. A Substudy Based on Two Randomised Clinical Trials
Abstract
Background: Peripheral nerve blocks (PNBs) are a cornerstone in postoperative pain management, reducing pain, opioid consumption, and opioid-related adverse effects. However, the duration of PNBs is limited and might result in rebound pain after block cessation. Dexamethasone, a synthetic glucocorticoid, when administered in addition to PNBs, prolongs block duration and might mitigate rebound pain. We assessed the effect of adjunct dexamethasone on pain after block cessation and rebound pain.
Methods: This is a substudy pooling data from two randomised, placebo-controlled three-arm clinical trials conducted between June 9, 2022 and May 17, 2023. Participants underwent osseous surgery of either the lower or upper limb under peripheral nerve block. Participants were allocated to dexamethasone (12 mg oral, 24 mg oral, or 12 mg intravenous) or placebo (oral or intravenous). The primary outcome was pain immediately after block cessation (Numerical Rating Scale, NRS, 0 to 10) and rebound pain (NRS ≥ 7 immediately after block cessation).
Results: Data from 159 participants were included. Fifty-six participants received placebo and 103 participants received dexamethasone. The median pain score after block cessation was 5.0 points (IQR 3.0 to 8.0) in the placebo group and 3.0 points (IQR 1.0 to 6.0) in the dexamethasone group. Rebound pain occurred in 20 of 56 participants (35.7%) in the placebo group and in 19 out of 103 participants (18.4%) in the dexamethasone group. Dexamethasone…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 159 participants or records.
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