Intravenous Dexamethasone for Prolonged Duration of Axillary Nerve Blockade

Pain management among patients undergoing orthopedic surgery is often a challenge. Regional anesthesia has become a popular anesthetic technique providing optimal pain control during the intraoperative and postoperative periods. A 61-year-old woman presented for an open reduction and internal fixation of bilateral distal radius fractures. The patient underwent general anesthesia and received bilateral axillary nerve blocks. A single 8-mg dose of dexamethasone was given intravenously to prolong the analgesic effect of the axillary nerve blocks. The patient did not receive opioids in the immediate postoperative setting and received only one dose of intravenous morphine during her hospital stay. Current research has shown prolonged analgesic effects when dexamethasone is administered either intravenously or perineurally. However, the Food and Drug Administration has not approved perineural administration of dexamethasone. Intravenous administration of dexamethasone prolongs analgesic effects equivalently. This case study supports previous findings suggesting that dexamethasone, 8 mg, administered intravenously prolongs the duration of analgesia when used in conjunction with bupivacaine in a peripheral nerve block.