title: Duration of upper and lower extremity peripheral nerve blockade is prolonged with dexamethasone when added to ropivacaine: a retrospective database analysis.
abstract: BACKGROUND
  Dexamethasone, when added to local anesthetics, has been shown to prolong the duration of peripheral nerve blocks; however, there are limited studies utilizing large numbers of patients. The purpose of this study was to examine the effect of adding dexamethasone to ropivacaine on duration of nerve blocks of the upper and lower extremity.
  
  
  METHODS
  We reviewed 1,040 patient records collected in an orthopedic outpatient surgery center that had received an upper or lower extremity peripheral nerve block with ropivacaine 0.5% with or without dexamethasone and/or epinephrine. The primary outcome was duration of analgesia in upper or lower extremity blocks containing dexamethasone as an adjunct. Secondary outcomes included postoperative patient pain scores, satisfaction, and the incidence of block related complications. Linear and ordinal logistic regression models were used to examine the independent effect of dexamethasone on outcomes.
  
  
  RESULTS
  Dexamethasone was observed to increase median block duration by 37% (95% confidence interval: 31-43%). The increased block duration persisted within body regions (upper and lower) and across a range of block types. Dexamethasone was also observed to reduce pain scores on the day of surgery (P = 0.001) and postoperative day 1 (P < 0.001). There was no significant difference in duration of nerve blocks when epinephrine (1:400,000) was added to 0.5% ropivacaine with or without dexamethasone.
  
  
  CONCLUSIONS
  The addition of dexamethasone to 0.5% ropivacaine prolongs the duration of peripheral nerve blocks of both the upper and lower extremity.
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-5614, USA. sb.rasmussen@vanderbilt.edu
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Rasmussen
authors.forename: Nahel N
authors.initials: NN
authors.lastname: Saied
authors.forename: Clifford
authors.initials: C
authors.lastname: Bowens
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Mercaldo
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Malchow
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D016208:Databases, Factual; D003907:Dexamethasone / Q000009:adverse effects; D004837:Epinephrine; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D017060:Patient Satisfaction; D010525:Peripheral Nerves / Q000187:drug effects*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D000077212:Ropivacaine; D012678:Sensation Disorders / Q000453:epidemiology / Q000209:etiology; D012782:Shoulder / Q000601:surgery; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D000077212:Ropivacaine; D003907:Dexamethasone; D004837:Epinephrine
keywords: Acute Pain; Anesthesiology; Nerve Block; Postoperative Pain; Steroids