Background and Aims To our knowledge, the effect of oral dexamethasone on block duration has never been assessed. Previous trials used subanalgesic doses of dexamethasone (≤10 mg), and it is unclear if there is a ceiling effect.
Methods We randomised 180 participants undergoing osseous surgery of the hand or forearm to one oral dose of 24 mg dexamethasone, 12 mg dexamethasone, or placebo prior to performing a lateral infraclavicular block with 30 ml of 5 mg/ml ropivacaine. The primary outcome was the duration of analgesia assessed by the time to first sensation of pain in the surgical area. We pre-defined a 33% increase in the duration of analgesia as clinically important.
Results The duration of analgesia was 1256 ± 395 minutes with 24 mg dexamethasone, 1171 ± 318 with 12 mg dexamethasone, and 841 ± 327 minutes with placebo (figure 1). When compared with placebo, the duration of analgesia was greater with 24 mg dexamethasone (mean difference (MD) 412 minutes, 98.33% CI 248 to 577) and with 12 mg dexamethasone (MD 330 minutes, 98.33% CI 186 to 474). There was no significant difference between 24 mg and 12 mg dexamethasone (MD 85 minutes, 98.33% CI -78 to 249). The increase in the duration of analgesia exceeded the pre- defined level of clinical importance for both 24 mg and 12 mg dexamethasone when compared with placebo.
Conclusions Oral dexamethasone of 24 mg and 12 mg increased the duration of analgesia to a clinically important extent when compared with placebo. There was no significant dose-response effect of dexamethasone.
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