title: A randomised controlled trial of perineural vs intravenous dexamethasone for foot surgery.
abstract: We used 20 ml ropivacaine 0.75% for ankle blocks before foot surgery in 90 participants who we allocated in equal numbers to: perineural dexamethasone 8 mg and intravenous saline 0.9%; perineural saline 0.9% and intravenous dexamethasone 8 mg; or perineural and intravenous saline 0.9%. Dexamethasone increased the median (IQR [range]) time for the return of some sensation or movement, from 14.6 (10.8-18.8 [5.5-38.0]) h with saline to 24.1 (19.3-29.3 [5.0-44.0]) h when given perineurally, p = 0.00098, and to 20.9 (18.3-27.8 [8.8-31.3]) h when given intravenously, p = 0.0067. Dexamethasone increased the median (IQR [range]) time for the return of normal neurology, from 17.6 (14.0-21.0 [9.5-40.5]) h with saline to 27.5 (22.0-36.3 [7.0-53.0]) h when given perineurally, p = 0.00016, and to 24.0 (20.5-32.3 [13.0-42.5]) h when given intravenously, p = 0.0022. Dexamethasone did not affect the rates of block success, postoperative pain scores, analgesic use, or nausea and vomiting. The route of dexamethasone administration did not alter its effects.
authors.affiliation: Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: R L
authors.initials: RL
authors.lastname: Dawson
authors.affiliation: Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: D H
authors.initials: DH
authors.lastname: McLeod
authors.affiliation: Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: J P
authors.initials: JP
authors.lastname: Koerber
authors.affiliation: Pain Management Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: J L
authors.initials: JL
authors.lastname: Plummer
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedics SA, Adelaide, South Australia, Australia.
authors.forename: G C
authors.initials: GC
authors.lastname: Dracopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides; D000762:Anesthesia Recovery Period; D000779:Anesthetics, Local; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005528:Foot / Q000601:surgery*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D005938:Glucocorticoids; D012965:Sodium Chloride; D000077212:Ropivacaine; D003907:Dexamethasone