The effect of intravenous dexamethasone on rebound pain after wrist and hand surgery under supraclavicular brachial plexus blockade: a randomized placebo-controlled trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(19):15 Can J Anaesth . 2025 Jul;72(7):1079-1089.What this means for my practice?
A single preoperative IV dose of dexamethasone (0.11 mg/kg) meaningfully reduces and delays rebound pain after single-shot SCBPB for wrist/hand surgery, lowers opioid use, and improves early patient-reported outcomes without added short-term harm. Clinically, incorporating IV dexamethasone into multimodal analgesia for these cases can smooth the transition from block resolution to systemic analgesia and curb early opioid requirements. Limitations include single-centre design, modest sample size with some baseline imbalances, exclusion of diabetes, and 24-hr follow-up only.
Study Summary
Fifty-six patients undergoing elective wrist/hand bone surgery with ultrasound-guided single-shot supraclavicular brachial plexus block (SCBPB) were randomized to receive intravenous dexamethasone 0.11 mg/kg (n=28) or intravenous 0.9% saline (n=28). The primary outcome was the difference in pain scores before versus after block resolution (NRS 0–10). Secondary outcomes included incidence of rebound pain (NRS ≥7 after block resolution), pain at rest/on mobilization at 6, 12, and 24 hr, time to worst pain, cumulative opioid use (IV morphine equivalents), patient satisfaction and sleep quality, and block/opioid-related complications through 24 hr. Overall, the results showed dexamethasone significantly lowered the primary pain-difference score and reduced rebound pain incidence, opioid consumption, and early postoperative pain, while delaying both block resolution and time to worst pain. These findings suggest a single dose of IV dexamethasone meaningfully attenuates rebound pain after SCBPB for wrist/hand surgery without increasing short-term complications.
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