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