title: The Combination of IV and Perineural Dexamethasone Prolongs the Analgesic Duration of Intercostal Nerve Blocks Compared with IV Dexamethasone Alone.
abstract: The use of multiple-level, single-injection intercostal nerve blocks for pain control following video-assisted thorascopic surgery (VATS) is limited by the analgesic duration of local anesthetics. This study examines whether the combination of perineural and intravenous (IV) dexamethasone will prolong the duration of intraoperatively placed intercostal nerve blocks following VATS compared with IV dexamethasone and a perineural saline placebo.
  
  
  
  Prospective, double-blind, randomized placebo-controlled trial.
  
  
  
  Single level-1 academic trauma center.
  
  
  
  Forty patients undergoing a unilateral VATS under the care of a single surgeon.
  
  
  
  Patients were randomly assigned to two groups and received an intercostal nerve block containing 1) 0.5% bupivacaine with epinephrine and 1 ml of 0.9% saline or 2) 0.5% bupivacaine with epinephrine and 1 ml of a 4 mg/ml dexamethasone solution. All patients received 8 mg of IV dexamethasone.
  
  
  
  Group 2 had lower NRS-11 scores at post-operative hours 8 (5.05, SD = 2.13 vs 3.50, SD = 2.50; p  = 0.04), 20 (4.30, SD = 2.96 vs 2.26, SD = 2.31; p  = 0.02), and 24 (4.53, SD = 1.95 vs 2.26, SD = 2.31; p  = 0.02). Equianalgesic opioid requirement was decreased in group 2 at 32 hours (5.78 mg, SD = 5.77 vs 1.67 mg, SD = 3.49; p  = 0.02). Group 2 also had greater FEV1 measured at 8, 12, 24, and 44 hours; greater FVC at 24 hours; greater PEF at 28 through 48 hours; and greater FEV1/FVC at 8 and 36 hours.
  
  
  
  The combination of IV and perineural dexamethasone prolonged the duration of a single-injection bupivacaine intercostal nerve block as measured by NRS-11 compared with IV dexamethasone alone at 24 hours. Reduced NRS-11 at other times, reduced opioid requirements, and increased PFTs were observed in group 2.
authors.affiliation: Harvard Medical School, Department of Anesthesia, Massachusetts General Hospital, Boston, MA USA.
authors.forename: Dermot P
authors.initials: DP
authors.lastname: Maher
authors.affiliation: Department of Anesthesia, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Derek
authors.initials: D
authors.lastname: Serna-Gallegos
authors.affiliation: Department of Anesthesia, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Rodney
authors.initials: R
authors.lastname: Mardirosian
authors.affiliation: Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Otto J
authors.initials: OJ
authors.lastname: Thomas
authors.affiliation: Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: McKenna
authors.affiliation: Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Roya
authors.initials: R
authors.lastname: Yumul
authors.affiliation: Department of General Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Vida
authors.initials: V
authors.lastname: Zhang
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000378:metabolism; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000378:metabolism; D001340:Autonomic Nerve Block / Q000379:methods*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000378:metabolism; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000378:metabolism / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: Acute Pain; Outcome Assessment; Postoperative Pain; Steroids; Thoracic