Perineural Dexamethasone and Multimodal Perineural Analgesia: How Much Is Too Much?
Williams, Brian A. MD, MBA*; Schott, Nicholas J. MD†; Mangione, Michael P. MD‡; Ibinson, James W. MD, PhD*
As a clinical research community, the era of high-dose single perineural adjuvants (especially related to dexamethasone at doses >2 mg per nerve or plexus) needs to be relegated to legacy status. Our specialty must avoid the temptation to incorporate high-dose perineural dexamethasone into routine practice based on cursory skimming of the current article by Rahangdale et al.
14 and the recent meta-analysis by Choi et al.
20 To continue to incorporate high-dose perineural dexamethasone in our nerve blocks would be a significant setback in both patient care and in clinical research. When basic cytotoxicity research shows more neuronal death in a dose-response curve with higher concentrations of dexamethasone combined with clinically relevant concentrations of local anesthetics,
9 then our patients and our health care colleagues of all disciplines need to trust that we incorporate such basic science findings in our drug selection for off-label use.