Intravenous Dexamethasone Prolongs Opioid-Free Analgesia After Pediatric Hand Surgery: A Randomized Triple-Blind Trial.

Abstract

Background: Postoperative pain control after pediatric hand surgery remains challenging despite the increasing use of regional anesthesia. This randomized triple-blind trial evaluated whether adjunctive intravenous dexamethasone prolongs postoperative opioid-free analgesia after pediatric supraclavicular brachial plexus block.

Methods: Ninety children undergoing elective hand or wrist surgery were randomized to receive intravenous placebo, dexamethasone 0.1 mg/kg, or dexamethasone 0.2 mg/kg before ultrasound-guided supraclavicular brachial plexus block (30 patients/group). The primary outcome was time to first postoperative opioid administration within 48 hours. Secondary outcomes included opioid consumption, postoperative pain scores, time to first documented spontaneous finger movement, and adverse events.

Results: Intravenous dexamethasone significantly prolonged postoperative opioid-free analgesia compared with placebo. Median time to first rescue opioid administration was 8.9 hours in the placebo group, 14.3 hours in the dexamethasone 0.1 mg/kg group, and 17.3 hours in the dexamethasone 0.2 mg/kg group (P<0.0001). Patients receiving dexamethasone also demonstrated lower postoperative opioid consumption and lower pain scores during the 48-hour follow-up period. The time to first documented spontaneous finger movement was delayed in dexamethasone-treated patients. No serious adverse events were observed.

Conclusions: Adjunctive intravenous dexamethasone prolonged opioid-free analgesia and reduced postoperative opioid requirements after pediatric hand surgery. Although analgesic outcomes improved in a dose-dependent manner, higher dexamethasone doses were associated with longer time to first documented spontaneous finger movement.

Level of evidence: Level I-therapeutic study.