Analgesic comparison between perineural and intravenous dexamethasone for shoulder arthroscopy: a meta-analysis of randomized controlled trials

Liangku Huang,Zandong Zhao,Haizhen Zhou,Peng Li,Liang Zhang,Guangming Kang

doi:10.1186/s13018-022-02952-6

Liangku Huang, Zandong Zhao + Show 4 more

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https://doi.org/10.1186/s13018-022-02952-6

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Abstract

IntroductionThe analgesic comparison between perineural and intravenous dexamethasone on interscalene block for pain management after shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of perineural versus intravenous dexamethasone on interscalene block for pain control after shoulder arthroscopy.MethodsWe have searched PubMed, Embase, Web of science, EBSCO and Cochrane library databases through April 2021 and included randomized controlled trials (RCTs) assessing the effect of perineural and intravenous dexamethasone on interscalene block in patients with shoulder arthroscopy.ResultsFive RCTs were included in the meta-analysis. Overall, compared with intravenous dexamethasone for shoulder arthroscopy, perineural dexamethasone led to similar block duration (SMD = 0.12; 95% CI − 0.12 to 0.35; P = 0.33), pain scores at 12 h (SMD = − 0.67; 95% CI − 1.48 to 0.15; P = 0.11), pain scores at 24 h (SMD = − 0.33; 95% CI − 0.79 to 0.14; P = 0.17), opioid consumption (SMD = 0.01; 95% CI − 0.18 to 0.19; P = 0.95) and incidence of nausea/vomiting (OR = 0.74; 95% CI 0.38–1.44; P = 0.38).ConclusionsPerineural and intravenous dexamethasone demonstrated comparable pain relief after shoulder arthroscopy.

Highlights

The analgesic comparison between perineural and intravenous dexamethasone on interscalene block for pain management after shoulder arthroscopy remains controversial
Significant postoperative pain is the main concern after this surgery and effective analgesia is required for this day-case surgery
Interscalene brachial plexus block (ISB) is limited by short analgesic maintenance for several hours, and especially moderate to severe pain of this surgery requires opioid supplementation [9]

Summary

Introduction

The analgesic comparison between perineural and intravenous dexamethasone on interscalene block for pain management after shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of perineural versus intravenous dexamethasone on interscalene block for pain control after shoulder arthroscopy. Interscalene brachial plexus block (ISB) is the standard analgesia after shoulder surgery with the features of superior analgesia and reduced opioid consumption [6,7,8]. ISB is limited by short analgesic maintenance for several hours, and especially moderate to severe pain of this surgery requires opioid supplementation [9]. The increase in the dose of local anesthetic is used to prolong ISB, but has the limitation of narrow therapeutic window and volume/concentration. Volumes of 10 ml or greater injected into the interscalene groove can increase the risk of ipsilateral hemi-diaphragmatic paresis [10]

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