TY - JOUR
T1 - Effect of intravenous dexamethasone on the anaesthetic characteristics of peripheral nerve block
T2 - a double-blind, randomised controlled, dose-response volunteer study
AU - Short, Anthony
AU - El-Boghdadly, Kariem
AU - Clarke, Hance
AU - Komaba, Tomomi
AU - Jin, Rongyu
AU - Chin, Ki Jinn
AU - Chan, Vincent
N1 - Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
PY - 2020/1
Y1 - 2020/1
N2 - BACKGROUND: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block.METHODS: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects.RESULTS: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects.CONCLUSIONS: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear.CLINICAL TRIAL REGISTRATION: NCT02864602 (clinicaltrials.gov).
AB - BACKGROUND: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block.METHODS: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects.RESULTS: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects.CONCLUSIONS: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear.CLINICAL TRIAL REGISTRATION: NCT02864602 (clinicaltrials.gov).
KW - Adjuvants, Anesthesia/administration & dosage
KW - Administration, Intravenous
KW - Adult
KW - Cross-Over Studies
KW - Dexamethasone/administration & dosage
KW - Dose-Response Relationship, Drug
KW - Double-Blind Method
KW - Female
KW - Hand Strength
KW - Healthy Volunteers
KW - Humans
KW - Male
KW - Median Nerve
KW - Middle Aged
KW - Nerve Block/adverse effects
KW - Pain Threshold/drug effects
KW - Peripheral Nerves
KW - Sensation/drug effects
KW - Thermosensing/drug effects
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85073520018&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2019.08.029
DO - 10.1016/j.bja.2019.08.029
M3 - Article
C2 - 31711605
SN - 0007-0912
VL - 124
SP - 92
EP - 100
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 1
ER -