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Dexamethasone As an Adjuvant to Peripheral Nerve Block (Review)

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Dexamethasone As an Adjuvant to Peripheral Nerve Block (Review) Cochrane Database of Systematic Reviews Dexamethasone as an adjuvant to peripheral nerve block (Review) Pehora C, Pearson AME, Kaushal A, Crawford MW, Johnston B Pehora C, Pearson AME, Kaushal A, Crawford MW, Johnston B. Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD011770. DOI: 10.1002/14651858.CD011770.pub2. www.cochranelibrary.com Dexamethasone as an adjuvant to peripheral nerve block (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 3 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 7 OBJECTIVES ..................................... 8 METHODS ...................................... 8 RESULTS....................................... 11 Figure1. ..................................... 12 Figure2. ..................................... 15 Figure3. ..................................... 16 Figure4. ..................................... 18 Figure5. ..................................... 21 Figure6. ..................................... 21 Figure7. ..................................... 23 Figure8. ..................................... 25 Figure9. ..................................... 25 ADDITIONALSUMMARYOFFINDINGS . 29 DISCUSSION ..................................... 34 AUTHORS’CONCLUSIONS . 36 ACKNOWLEDGEMENTS . 37 REFERENCES ..................................... 37 CHARACTERISTICSOFSTUDIES . 42 DATAANDANALYSES. 97 Analysis 1.1. Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 1 Duration of sensoryblock................................... 109 Analysis 1.2. Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 2 Duration of sensory block: long- versus medium-acting local anaesthetic subgroups. 110 Analysis 1.3. Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 3 Duration of sensory block: additive versus no additive subgroups. ............... 112 Analysis 1.4. Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 4 Duration of sensory block: high- versus low-dose dexamethasone subgroups. ................ 114 Analysis 1.5. Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 5 Duration of sensory block: high/unclear versus low risk of bias subgroups. ................. 116 Analysis 2.1. Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 1 Duration of motorblock. .................................. 118 Analysis 2.2. Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 2 Duration of motor block: long- versus medium-acting local anaesthetic subgroups. .............. 119 Analysis 2.3. Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 3 Duration of motor block: additives verus no additives subgroups. .............. 120 Analysis 2.4. Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 4 Duration of motor block: high- versus low-dose dexamethasone subgroups. ................. 121 Analysis 2.5. Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 5 Duration of motor block: high/unclear versus low risk of bias subgroups. ................. 123 Analysis 3.1. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 1 Overall incidence of block-related adverse events. .............. 124 Analysis 3.2. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 2 Numbness/tingling 14 days after surgery. ............ 125 Analysis 3.3. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 3 Residual motor block/weakness 24 hours after surgery. ............... 126 Dexamethasone as an adjuvant to peripheral nerve block (Review) i Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 3.4. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome4HornerSyndrome.. 127 Analysis 3.5. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome5Hoarseness. 128 Analysis 3.6. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 6 Diaphragmatic paresis. 129 Analysis 3.7. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome7Dyspnoea.. 130 Analysis 3.8. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome8Vascularinjury. 131 Analysis 3.9. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome9Cranialnerve12palsy. 132 Analysis 3.10. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome10Bruising.. 133 Analysis 3.11. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 11 Overall non-block-related adverse events. ............ 134 Analysis 3.12. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 12 Postoperative nausea and vomiting. .......... 135 Analysis 3.13. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome13Deepsedation.. 136 Analysis 3.14. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 14 Dermatological symptoms (pruritus/rash). ........... 137 Analysis 3.15. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome15Syncope/fainting. 138 Analysis 3.16. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome16Bradycardia.. 139 Analysis 3.17. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome17Hypotension. 140 Analysis 3.18. Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 18 Headache/10-pound fluid gain/diarrhoea/frequent urination/muscle soreness. 141 Analysis 4.1. Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at12 hours. .......... 142 Analysis 4.2. Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 12 hours: medium- versus long-acting local anaesthetic subgroups. 143 Analysis 4.3. Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 12 hours: additive versus no additive subgroups. 144 Analysis 4.4. Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 4 Postoperative pain intensity at 12 hours: high- versus low-dose dexamethasone subgroups. 145 Analysis 4.5. Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 5 Postoperative pain intensity at 12 hours: high/unclear versus low risk of bias subgroups. 146 Analysis 5.1. Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at 24 hours. .......... 147 Analysis 5.2. Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 24 hours: long- versus medium-acting local anaesthetic subgroups. 148 Analysis 5.3. Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 24 hours: additive versus no additive subgroups. 149 Analysis 5.4. Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 4 Postoperative pain intensity at 24 hours: high- versus low-dose dexamethasone subgroups. 150 Analysis 5.5. Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 5 Postoperative pain intensity at 24 hours: high/unclear versus low risk of bias subgroups. 151 Analysis 6.1. Comparison 6 Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at 48 hours. .......... 152 Dexamethasone as an adjuvant to peripheral nerve block (Review) ii Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 6.2. Comparison 6 Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 48 hours: additives versus no additives subgroups. 153 Analysis 6.3. Comparison 6 Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 48 hours: high/unclear versus low risk of bias subgroups. 154 Analysis 7.1. Comparison 7 Postoperative opioid consumption at 24 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative opioid consumption at 24 hours. ............. 155 Analysis 7.2. Comparison
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