IV Dexamethasone Cuts Postblock Pain After Hand Surgery
TOPLINE:
In patients undergoing elective orthopedic wrist and hand surgery, IV administration of 0.11 mg/kg of dexamethasone before the operation significantly reduced the occurrence and severity of rebound pain after the resolution of the supraclavicular brachial plexus blockade and decreased the use of opioid analgesia.
METHODOLOGY:
Researchers conducted a prospective randomized trial at a Korean medical center between May 2022 and September 2023 to evaluate the effect of IV dexamethasone on rebound pain in 56 adults undergoing elective orthopedic wrist and hand surgery under supraclavicular brachial plexus blockade.
The patients were randomly assigned to receive a 10 mL solution of either 0.11 mg/kg dexamethasone (n = 28; mean age, 49 years; 57% women) or 0.9% saline (control group; n = 28; mean age, 54.5 years; 46% women).
Following the administration of a mixture of local anesthetics, dexamethasone or saline was administered immediately after the block.
The primary outcome was the difference in worst pain scores before the block and within 12 hours after its resolution.
Secondary outcomes were the incidence of rebound pain (defined as the sudden occurrence of severe pain with a numeric rating scale score ≥ 7 at the site of surgery after resolution of the block), cumulative consumption of opioids, and block-related complications.
TAKEAWAY:
The patients in the control group had a larger difference in pain scores — which the researchers calculated as the worst pain score within 12 hours of the resolution of the block minus the pain score before the block resolved — than those in the dexamethasone group (mean, 7.3 vs 4.7; mean difference between groups, 2.6; P < .001).
Rebound pain occurred more frequently in the control group than in the dexamethasone group (79% vs 32%; P < .001); severity of pain at rest and on mobilization was higher in the control group at 6 and 12 hours (P < .001 for both) but not at 24 hours after surgery.
The cumulative consumption of opioids was significantly lower in the dexamethasone group than in the control group at 6, 12, and 24 hours after surgery (P < .001 for all).
The dexamethasone group reported significantly higher satisfaction and better quality of sleep than the control group, with no block-related complications in either group.
IN PRACTICE:
'Intravenous dexamethasone effectively mitigates rebound pain after SCBPB [supraclavicular brachial plexus blockade], ensuring a smoother transition from dense blockade to systemic analgesia,' the researchers reported.
SOURCE:
This study was led by RyungA Kang, MD, PhD, and Yu Jeong Bang, MD, of Sungkyunkwan University School of Medicine in Seoul, Republic of Korea. It was published online on June 20, 2025, in Canadian Journal of Anesthesia.
LIMITATIONS:
This study was conducted at a single center and had a relatively small sample size, limiting the generalizability of the findings. The results might vary with combinations of local anesthetics other than the ones used in this study (2% lidocaine and 0.75% ropivacaine with epinephrine). The dose and timing of administration of dexamethasone was selected based on a prior meta-analysis, but the optimal strategy to prevent rebound pain remained undefined.
DISCLOSURES:
This study did not receive any specific funding. The authors declared having no potential conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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