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Low-Dose Perineural Dexamethasone Enhances Analgesia After Pediatric Hand Surgery Without Elevating Systemic Stress
Tomasz Reysner1, Bahadir Ciftci2,3, Szymon Bialka4
1Departments of Clinical Anesthesiology and Pain Medicine.
Insights
Low-dose perineural dexamethasone effectively prolongs postoperative analgesia and reduces opioid use in children undergoing upper limb surgery. This approach is safe, showing no adverse systemic effects, with a lower dose potentially optimizing recovery.
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.
Background:
Supraclavicular brachial plexus block is a widely used technique for upper limb surgery in children. Although perineural dexamethasone has demonstrated efficacy in prolonging analgesia in adults, data on its optimal dosing and systemic safety in pediatric patients are limited. This study aimed to evaluate whether low-dose perineural dexamethasone can prolong postoperative analgesia without increasing systemic stress markers in young children undergoing hand or wrist surgery.
Methods:
In this triple-blinded, randomized controlled trial (ClinicalTrials.gov Identifier: NCT06086392), 90 children aged 3 months to 6 years undergoing elective upper extremity surgery were assigned to receive supraclavicular brachial plexus block with 0.2% ropivacaine combined with either normal saline (control), dexamethasone 0.05 mg/kg, or dexamethasone 0.1 mg/kg. The primary outcome was time from arrival in the postanesthesia care unit to first administration of rescue opioid analgesia. Secondary outcomes included total opioid consumption, postoperative pain intensity using the FLACC scale, blood glucose levels, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and time to motor recovery.
Results:
Both dexamethasone groups demonstrated significantly prolonged time to first opioid use compared with the control group (mean±SD: 19.4±2.2 h in the 0.1 mg/kg group, 16.0±1.9 h in the 0.05 mg/kg group, and 8.5±1.3 h in controls; P<0.0001). Total opioid consumption was significantly reduced in the dexamethasone groups. Postoperative pain scores were lower in both intervention groups, especially during the first 12 hours. No significant differences were found among groups in blood glucose, inflammatory markers, or incidence of nerve deficits. Motor recovery was delayed in the dexamethasone groups but did not interfere with early mobilization.
Conclusions:
Low-dose perineural dexamethasone (0.05 to 0.1 mg/kg) safely and effectively prolongs postoperative analgesia and reduces opioid needs in children undergoing upper limb surgery, without causing systemic metabolic or inflammatory disturbances. The 0.05 mg/kg dose may offer a more favorable balance between analgesic efficacy and motor recovery time.
Level Of Evidence:
Level I-randomized controlled trial.
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