Effect of dexamethasone on rebound pain and analgesic effects after upper limb surgery under brachial plexus block: a...

To systematically evaluate the effect of dexamethasone on rebound pain after brachial plexus block upper limb surgery and its impact on analgesic optimization through the method of meta-analysis.

Registered in PROSPERO. Randomized controlled trials (RCTs) on the application of dexamethasone in upper limb fracture surgery under brachial plexus block were retrieved from the PubMed, Medline and Embase databases. RevMan 5.4 was used by two independent researchers to screen the literature gradually, evaluate its quality, extract the data, and finally merge the data.

Seven studies involving 485 patients were included. The comprehensive results showed that dexamethasone could reduce the incidence of rebound pain (RR = 0.38, 95% CI 0.28-0.51, P < 0.00001, I² = 0%). Dexamethasone reduced the incidence of postoperative nausea and vomiting (PONV) (RR = 0.59, 95% CI 0.40-0.89, P = 0.01, I ² = 19%). Dexamethasone prolonged the time to first rescue analgesia (SMD = 1.70, 95% CI 1.05-2.36, P < 0.00001, I ² = 75%). Dexamethasone reduced the VAS score at 12 h after surgery (SMD = -2.61, 95% CI -4.51- 0.70, P = 0.007, I ² = 98%).

Dexamethasone, as an adjuvant, maybe can reduce the incidence of postoperative rebound pain under brachial plexus block for upper extremity surgery, lower the VAS score at 12 h postoperatively, reduce the incidence of PONV, and prolong the first rescue time for postoperative analgesia, thereby optimizing its postoperative analgesic effect.