Dexamethasone for nerve blocks: Design matters!

With a few notable exceptions, efforts to prolong peripheral nerve blocks with adjuvant drugs have been generally disappointing. One prime exception is dexamethasone: it has been demonstrated to prolong analgesia as well as sensory and motor block in multiple contexts, although numbers are too low to make definitive statements about safety [1]. All the early studies, however, assumed the action of dexamethasone was on the peripheral nerve and therefore did not include systemic controls. Desmet and colleagues upset the apple cart in 2013 with their report that 10mg of systemic dexamethasone appears to prolong the time to first analgesic request as much as perineural administration [2].

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