Effect of Perineural Dexamethasone on the Duration of Analgesia in Paravertebral Block: A Meta-Analysis

The aim of this meta-analysis was to evaluate the effect of perineural (PN) dexamethasone on the duration of analgesia in paravertebral block (PVB).

We systematically searched PubMed, Embase, Web of Science, The Cochrane Library, and CNKI up to October 2025 for relevant randomized controlled trials (RCTs) comparing PN dexamethasone to a placebo in PVB. The primary outcome was the duration of analgesia. The mean difference (MD) and the risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. Trial sequential analysis (TSA) was also carried out to calculate the required information size (RIS).

Ten trials with 731 participants were included. PN dexamethasone prolonged the duration of analgesia by approximately 350 minutes compared with placebo. In the trial sequential analysis, the cumulative Z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, and reached RIS. In addition, PN dexamethasone decreased Visual analogue scale (VAS) scores at 2 hours, 6 hours, 12 hours and 24 hours after surgery with lower incidence of postoperative nausea and vomiting (PONV, risk ratio [RR] 0.41; 95% CI 0.25 to 0.69) and less cumulative opioid consumption (MD = -8.85; 95% CI: -13.39 to -4.32).

This study suggested PN dexamethasone effectively prolongs the duration of analgesia in PVB and reduces the cumulative opioid consumption. TSA suggested that no more trials are required to confirm that PN dexamethasone effectively prolongs the duration of analgesia in PVB.