Perineural dexamethasone enhances analgesic duration of erector spinae plane block in total hip arthroplasty: A randomized quadruple-blind controlled trial

Abstract

Background

Total hip arthroplasty (THA) is associated with significant postoperative pain, which can impair early mobilization and recovery. Erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique for lower limb surgeries. However, the duration of single-shot ESPB is limited. This study aimed to assess the effect of perineural dexamethasone as an adjunct to ropivacaine in prolonging analgesia and reducing opioid requirements in patients undergoing THA.

Methods

In this randomized, quadruple-blinded, controlled trial, 60 patients aged ≥65 years scheduled for elective THA under spinal anesthesia were assigned to receive ultrasound-guided ESPB with either 20 mL of 0.2 % ropivacaine plus 2 mL saline (control group) or 20 mL of 0.2 % ropivacaine plus 4 mg perineural dexamethasone (dexamethasone group). The primary outcome was time to first rescue opioid analgesia. Secondary outcomes included total opioid consumption, Numerical Rating Scale (NRS) pain scores, motor strength, nerve safety, and blood glucose levels over 48 h postoperatively.

Results

The dexamethasone group showed a significantly prolonged time to first opioid use (16.0 ± 1.3 vs. 8.9 ± 1.7 h; p < 0.0001) and reduced opioid consumption (3.5 ± 4.8 vs. 19.2 ± 12.2 MME; p < 0.0001). NRS scores were consistently lower beyond the 4-h time point. No motor deficits, nerve injuries, or hyperglycemia were observed.

Conclusions

Perineural dexamethasone significantly enhances the analgesic efficacy of ESPB in THA without compromising safety. This simple adjunct offers substantial benefit in postoperative pain control and opioid reduction.