Decadron Blocks

[GaseousClay]

A lot of you guys on here are posting amazing numbers with PF decadron + bupi or ropi. What are you basing your number of hours on? I assume most patients are gone home so are you just calling and asking when they think the block wore off or when they needed pain rx? I have done this on occasion, being a resident and I feel like it works great. The pushback I get from the attendings is that 1) not FDA approved (although lumbar ESI are not FDA approved), 2) If theres a nerve injury issue it may be indefensible in court. It is not a standard of care and most regional anesthesia experts would not use it so seems like you would lose the case regardless if its a surgical issue or regional anesthetic issue. 3) most recent paper in A&A (The Effects of Perineural Versus Intravenous Dexamethasone on Sciatic Nerve Blockade Outcomes: A Randomized, Double-Blind, Placebo-Controlled Study) showed that "There was no significant difference in the time to first toe movement or analgesia duration between the perineural and IV dexamethasone groups.Postoperative opioid consumption was not different among study groups."
So just want to know what you private practice guys think and how you justify the risk in doing this? Thanks

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[Noyac]

I can't "justify" using it in research terms. But I have been adding decadron to my blocks for over three years now and even had it placed in my own FNB for an ACL repair I had a couple years ago. I would say that the difference is seems to be there and more research is therefore warranted. How's that for PC?

My experience, my ACL repair didn't hurt for 2 days. PT is what actually woke it up. Then it hurt for a few nights. Those of you that have had ACL's will know that that is impressive. However, I had motor function the evening of surgery which confused me since I could fire my quads but the pain was very little. This is not what I would tell pts to expect though. Everyone is a bit different. It's possible that I had even through enough trauma that the ACL repair just didn't impress me that much with regards to pain.

My pts experiences are variable. I would need to have to seriously look at the differences btw decadron and not which I just don't have the time or energy to do. So in other words, it is subjective.

 

[Orin]

"There was no significant difference in the time to first toe movement or analgesia duration between the perineural and IV dexamethasone groups.Postoperative opioid consumption was not different among study groups."

I guess I read that study and said great, so I can inject it near the nerve and get the same results as systemic dexamethasone. The question becomes whether it avoids the negative aspects of IV Dexamethasone.

This other paper, http://www.ncbi.nlm.nih.gov/pubmed/23587875, suggested there might be though they didn't really look at it, with higher post-operative glucoses on the IV vs perineural steroid.

The studies really only find equivalence when you use 8 or 10 mg of Dex, while the lower dose ones don't show equivalence for IV over perineural.
http://www.ncbi.nlm.nih.gov/pubmed/24817819

 

[dhb]

3) most recent paper in A&A (The Effects of Perineural Versus Intravenous Dexamethasone on Sciatic Nerve Blockade Outcomes: A Randomized, Double-Blind, Placebo-Controlled Study) showed that "There was no significant difference in the time to first toe movement or analgesia duration between the perineural and IV dexamethasone groups.Postoperative opioid consumption was not different among study groups."
So just want to know what you private practice guys think and how you justify the risk in doing this? Thanks

Everyone that has been doing nerve blocks knows this is absolutely not true, the good side of it is that you can chart it iv and give in the block.