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5070
Perineural Dexamethasone Prolongs Adductor Canal Block When Assessed Objectively
Session: MP-06a
Fri, April 20, 10:15-11:45 am
Shubert (Shubert Complex), 6th floor

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Perineural Dexamethasone Prolongs Adductor Canal Block When Assessed Objectively

Zachary McKee, MD; Sean Dobson, MD, PhD; Daryl Henshaw, MD; Robert Weller, MD;

J. Douglas Jaffe, DO; Christopher Edwards, MD; Wells Reynolds, MD; James Turner, MD

Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC

Section of Regional Anesthesia and Acute Pain Management

 

Introduction

Dexamethasone, a glucocorticoid with minimal mineralocorticoid effect, has garnered interest recently as both an intravenous (IV) and perineural (off-label) perioperative analgesic.  IV dexamethasone has been shown to be opioid sparing in doses ≥0.1mg/kg [1], and further research has found both IV and perineural dexamethasone to prolong the duration of peripheral nerve block (PNB).  Additionally, a recent systematic review and meta-analysis concluded that the use of perineural dexamethasone as an additive to local anesthetic may prolong the duration of PNB by an additional 3 hours when compared to a PNB and IV dexamethasone combination [2]. Most previous studies have utilized subjective end-points such as time-to-first-analgesic-request, opioid consumption, and patient-determined block duration to measure duration of PNB or analgesia.  While these outcomes may all be clinically relevant, they do not necessarily equate to block duration. The aim of this study was to determine whether perineural dexamethasone prolongs an adductor canal block (ACB) when a more objective method of determining block duration is employed.  In addition, the study was designed to examine a lower and theoretically safer (perineural use) dose could be equally effective given some concerns that higher than necessary doses of perineural dexamethasone are being utilized [3]. We hypothesized that 1mg and 4mg of perineural dexamethasone would be equally effective at prolonging an ACB when measured objectively by serial pin-prick examination and that both doses would be superior to placebo.

 

Materials and Methods

•This was an IRB approved patient-and-observer blinded, prospective, randomized, placebo-controlled equivalency trial
•FDA Investigational New Drug Exemption was obtained for the off-label use of dexamethasone
•85 participants undergoing medial or patellofemoral knee replacement surgery were enrolled  
•Three arms (12 in placebo group, 36 in 1mg group, 37 in 4mg group)
•All patients received an ACB with 20 cc’s of 0.25% bupivacaine with 1:400,000 epinephrine and 0, 1, or 4mg perineural dexamethasone
•An objective sensory assessment (pin-prick) occurred 15 minutes after block placement and then every 2-hours beginning 6 hours post-operatively
•Primary outcome: duration of sensory block in the saphenous nerve distribution – time from block until block resolution
•Secondary outcomes: serial verbal pain scores, cumulative opioid consumption, and time-to-first-analgesic request
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