Équivalence de l’efficacité analgésique entre la dexaméthasone administrée par voie périnerveuse vs intraveineuse en tant qu’adjuvant à un bloc du nerf périphérique

revue systématique et méta-analyse

Translated title of the contribution: Equivalent analgesic effectiveness between perineural and intravenous dexamethasone as adjuvants for peripheral nerve blockade: a systematic review and meta-analysis

Nasir Hussain, Tom van Den Langenbergh, Corey Sermer, Manuel L. Fontes, Amit Atrey, Naum Shaparin, Tamara R. Sawyer, Amaresh Vydyanathan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Dexamethasone is commonly used as an adjuvant to local anesthetics for peripheral nerve blockade; however, uncertainty persists regarding its optimal route of administration and safety. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare the incremental benefits of intravenous (IV) vs perineural (PN) dexamethasone when used as adjuvants for peripheral nerve blockade to improve analgesia. Sources: A search strategy was developed to identify eligible articles from the Cochrane and National Library of Medicine databases from inception until June 2017. The National Center for Biotechnology Information Medical Subject Headings browser thesaurus was used to identify search terms and combinations of keywords. Any clinical trial that randomly allocated adult patients (≥ 18 yr old) to receive either IV or PN dexamethasone for peripheral nerve blockade was considered for inclusion. Principal findings: After full-text screening of potentially eligible articles, 14 RCTs were included in this review. Overall, the use of PN dexamethasone did not provide a significant incremental benefit to the duration of analgesia [ratio of means (ROM), 1.23; Hartung-Knapp-Sidik-Jonkman (HKSJ) 95% confidence interval (CI), 0.85 to 1.85; P = 0.23] or to motor block duration (ROM, 1.14; HKSJ 95% CI, 0.98 to 1.31; P = 0.07). Also, at 24-hr follow-up, there was no significant difference between the two groups regarding pain scores (standardized mean difference, 0.36; HKSJ 95% CI, -0.08 to 0.80; I2 = 75%; P = 0.09) and cumulative opioid consumption (mean difference, 5.23 mg; HKSJ 95% CI, -4.60 to 15.06; P = 0.15). Lastly, no long-term nerve-related complications were observed with the use of PN dexamethasone. Conclusions: The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade.

Original languageFrench
Pages (from-to)1-13
Number of pages13
JournalCanadian Journal of Anesthesia
DOIs
StateAccepted/In press - Nov 21 2017

Fingerprint

Nerve Block
Peripheral Nerves
Dexamethasone
Analgesics
Meta-Analysis
Confidence Intervals
Analgesia
Randomized Controlled Trials
Medical Subject Headings
Controlled Vocabulary
National Library of Medicine (U.S.)
Safety
Information Centers
Biotechnology
Local Anesthetics
Opioid Analgesics
Uncertainty
Clinical Trials
Databases
Pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{713b092530b8420a999576871863601f,
title = "{\'E}quivalence de l’efficacit{\'e} analg{\'e}sique entre la dexam{\'e}thasone administr{\'e}e par voie p{\'e}rinerveuse vs intraveineuse en tant qu’adjuvant {\`a} un bloc du nerf p{\'e}riph{\'e}rique: revue syst{\'e}matique et m{\'e}ta-analyse",
abstract = "Purpose: Dexamethasone is commonly used as an adjuvant to local anesthetics for peripheral nerve blockade; however, uncertainty persists regarding its optimal route of administration and safety. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare the incremental benefits of intravenous (IV) vs perineural (PN) dexamethasone when used as adjuvants for peripheral nerve blockade to improve analgesia. Sources: A search strategy was developed to identify eligible articles from the Cochrane and National Library of Medicine databases from inception until June 2017. The National Center for Biotechnology Information Medical Subject Headings browser thesaurus was used to identify search terms and combinations of keywords. Any clinical trial that randomly allocated adult patients (≥ 18 yr old) to receive either IV or PN dexamethasone for peripheral nerve blockade was considered for inclusion. Principal findings: After full-text screening of potentially eligible articles, 14 RCTs were included in this review. Overall, the use of PN dexamethasone did not provide a significant incremental benefit to the duration of analgesia [ratio of means (ROM), 1.23; Hartung-Knapp-Sidik-Jonkman (HKSJ) 95{\%} confidence interval (CI), 0.85 to 1.85; P = 0.23] or to motor block duration (ROM, 1.14; HKSJ 95{\%} CI, 0.98 to 1.31; P = 0.07). Also, at 24-hr follow-up, there was no significant difference between the two groups regarding pain scores (standardized mean difference, 0.36; HKSJ 95{\%} CI, -0.08 to 0.80; I2 = 75{\%}; P = 0.09) and cumulative opioid consumption (mean difference, 5.23 mg; HKSJ 95{\%} CI, -4.60 to 15.06; P = 0.15). Lastly, no long-term nerve-related complications were observed with the use of PN dexamethasone. Conclusions: The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade.",
author = "Nasir Hussain and {van Den Langenbergh}, Tom and Corey Sermer and Fontes, {Manuel L.} and Amit Atrey and Naum Shaparin and Sawyer, {Tamara R.} and Amaresh Vydyanathan",
year = "2017",
month = "11",
day = "21",
doi = "10.1007/s12630-017-1008-8",
language = "French",
pages = "1--13",
journal = "Canadian Anaesthetists Society Journal",
issn = "0832-610X",
publisher = "Canadian Anaesthetists Society",

}

TY - JOUR

T1 - Équivalence de l’efficacité analgésique entre la dexaméthasone administrée par voie périnerveuse vs intraveineuse en tant qu’adjuvant à un bloc du nerf périphérique

T2 - revue systématique et méta-analyse

AU - Hussain, Nasir

AU - van Den Langenbergh, Tom

AU - Sermer, Corey

AU - Fontes, Manuel L.

AU - Atrey, Amit

AU - Shaparin, Naum

AU - Sawyer, Tamara R.

AU - Vydyanathan, Amaresh

PY - 2017/11/21

Y1 - 2017/11/21

N2 - Purpose: Dexamethasone is commonly used as an adjuvant to local anesthetics for peripheral nerve blockade; however, uncertainty persists regarding its optimal route of administration and safety. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare the incremental benefits of intravenous (IV) vs perineural (PN) dexamethasone when used as adjuvants for peripheral nerve blockade to improve analgesia. Sources: A search strategy was developed to identify eligible articles from the Cochrane and National Library of Medicine databases from inception until June 2017. The National Center for Biotechnology Information Medical Subject Headings browser thesaurus was used to identify search terms and combinations of keywords. Any clinical trial that randomly allocated adult patients (≥ 18 yr old) to receive either IV or PN dexamethasone for peripheral nerve blockade was considered for inclusion. Principal findings: After full-text screening of potentially eligible articles, 14 RCTs were included in this review. Overall, the use of PN dexamethasone did not provide a significant incremental benefit to the duration of analgesia [ratio of means (ROM), 1.23; Hartung-Knapp-Sidik-Jonkman (HKSJ) 95% confidence interval (CI), 0.85 to 1.85; P = 0.23] or to motor block duration (ROM, 1.14; HKSJ 95% CI, 0.98 to 1.31; P = 0.07). Also, at 24-hr follow-up, there was no significant difference between the two groups regarding pain scores (standardized mean difference, 0.36; HKSJ 95% CI, -0.08 to 0.80; I2 = 75%; P = 0.09) and cumulative opioid consumption (mean difference, 5.23 mg; HKSJ 95% CI, -4.60 to 15.06; P = 0.15). Lastly, no long-term nerve-related complications were observed with the use of PN dexamethasone. Conclusions: The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade.

AB - Purpose: Dexamethasone is commonly used as an adjuvant to local anesthetics for peripheral nerve blockade; however, uncertainty persists regarding its optimal route of administration and safety. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare the incremental benefits of intravenous (IV) vs perineural (PN) dexamethasone when used as adjuvants for peripheral nerve blockade to improve analgesia. Sources: A search strategy was developed to identify eligible articles from the Cochrane and National Library of Medicine databases from inception until June 2017. The National Center for Biotechnology Information Medical Subject Headings browser thesaurus was used to identify search terms and combinations of keywords. Any clinical trial that randomly allocated adult patients (≥ 18 yr old) to receive either IV or PN dexamethasone for peripheral nerve blockade was considered for inclusion. Principal findings: After full-text screening of potentially eligible articles, 14 RCTs were included in this review. Overall, the use of PN dexamethasone did not provide a significant incremental benefit to the duration of analgesia [ratio of means (ROM), 1.23; Hartung-Knapp-Sidik-Jonkman (HKSJ) 95% confidence interval (CI), 0.85 to 1.85; P = 0.23] or to motor block duration (ROM, 1.14; HKSJ 95% CI, 0.98 to 1.31; P = 0.07). Also, at 24-hr follow-up, there was no significant difference between the two groups regarding pain scores (standardized mean difference, 0.36; HKSJ 95% CI, -0.08 to 0.80; I2 = 75%; P = 0.09) and cumulative opioid consumption (mean difference, 5.23 mg; HKSJ 95% CI, -4.60 to 15.06; P = 0.15). Lastly, no long-term nerve-related complications were observed with the use of PN dexamethasone. Conclusions: The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade.

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