Low-Dose Perineural Dexamethasone Enhances Analgesia After Pediatric Hand Surgery Without Elevating Systemic Stress...

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Pharmacology

Background:

• Supraclavicular brachial plexus block is standard for pediatric upper limb surgery.
• Perineural dexamethasone efficacy in children requires further dose-finding and safety data.
• Systemic stress markers in pediatric patients receiving dexamethasone are not well-documented.

Purpose of the Study:

• To evaluate low-dose perineural dexamethasone for prolonged postoperative analgesia in children.
• To assess systemic safety by monitoring stress markers.
• To determine optimal dosing for pediatric upper extremity surgery.

Main Methods:

• Randomized controlled trial (NCT06086392) involving 90 children (3 months-6 years).
• Comparison of supraclavicular brachial plexus block with ropivacaine plus saline, dexamethasone 0.05 mg/kg, or dexamethasone 0.1 mg/kg.
• Primary outcome: time to first rescue opioid; secondary outcomes: pain scores, opioid consumption, glucose, inflammatory markers, motor recovery.

Main Results:

• Both dexamethasone doses significantly prolonged time to first opioid analgesia (16.0-19.4 hours vs. 8.5 hours for control).
• Opioid consumption and pain scores were reduced in dexamethasone groups, particularly within the first 12 hours.
• No significant differences in blood glucose or inflammatory markers; motor recovery was slightly delayed but did not impede mobilization.

Conclusions:

• Low-dose perineural dexamethasone (0.05-0.1 mg/kg) is safe and effective for pediatric upper limb surgery.
• It prolongs analgesia and reduces opioid requirements without systemic adverse effects.
• The 0.05 mg/kg dose may provide a better balance between pain relief and motor function recovery.