Low-Dose Perineural Dexamethasone Enhances Analgesia After Pediatric Hand Surgery Without Elevating Systemic Stress Markers: A Randomized Controlled Trial.
Tomasz Reysner, Bahadir Ciftci, Szymon Bialka et al.
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In 30 seconds
This triple-blinded randomized controlled trial evaluated perineural dexamethasone with supraclavicular brachial plexus block in 90 children aged 3 months to 6 years undergoing elective upper-extremity surgery. Compared with saline, both dexamethasone doses prolonged time to first rescue opioid: 19.4±2.2 h with 0.1 mg/kg and 16.0±1.9 h with 0.05 mg/kg, versus 8.5±1.3 h in controls (P <0.0001). Dexamethasone also reduced opioid consumption and pain scores, without significant differences in measured systemic stress markers. Motor recovery was delayed.
Key findings
- Time to first opioid use was 19.4±2.2 h with 0.1 mg/kg and 16.0±1.9 h with 0.05 mg/kg, versus 8.5±1.3 h with saline (P <0.0001).
- Total opioid consumption was significantly lower and pain scores were lower in both dexamethasone groups, particularly during the first 12 hours.
- Blood glucose, inflammatory markers, and incidence of nerve deficits did not differ significantly among groups.
- Motor recovery was delayed with dexamethasone, but the delay did not interfere with early mobilization.
Why it matters
For young children having upper-limb surgery, extending regional analgesia may reduce early postoperative pain and opioid requirements. The trial also assessed metabolic and inflammatory markers, finding no significant group differences, which informs consideration of systemic effects. The observed delay in motor recovery remains relevant when weighing analgesic benefit against recovery timing.
What to keep in mind
The abstract reports outcomes only in children aged 3 months to 6 years undergoing elective upper-extremity surgery; applicability to other populations or procedures is uncertain.