ASA Abstract Reviews

Perineural Dexamethasone, Intramuscular Dexamethasone, or Placebo in Children Receiving Femoral Nerve Block for Arthroscopic Knee Surgery: A Randomized Controlled Trial

Ellise C. Cappuccio, MD; Giorgio C. Veneziano, MD; Dmitry Tumin, PhD; David Martin, MD; Ralph Beltran, MD; Senthil G. Krishna, MD; Tarun Bhalla, MBA, MD; Joseph Tobias, MD
Nationwide Children's Hospital, Columbus, Ohio, United States
(Summarized and submitted by Ellise C. Cappuccio, MD)

Peri-neural dexamethasone has been shown to prolong analgesia in peripheral nerve blocks in adults; however, it’s efficacy in children and adolescents is not known. The idea behind using peripheral nerve blocks as part of the overall anesthetic plan is to minimize the use of parenteral and enteral opioids during the perioperative period and aid in same day discharge from the hospital. We sought to determine if the addition of dexamethasone to femoral nerve blocks decreased the total amount of opioids consumed after unilateral arthroscopic knee surgery in the pediatric population.

In a prospective, double-blind, randomized controlled trial at Nationwide Children's Hospital (forthcoming in Regional Anesthesia & Pain Medicine), we studied 77 patients ages 10 to 18 years and found that there was no significant difference in the total doses of opioids consumed in the first 48 hours among patients who received peri-neural or intramuscular dexamethasone with a femoral nerve block of ropivacaine 0.5% and patients who received femoral nerve block with ropivacaine 0.5% alone. We also discovered that the number of doses of opioid medications taken after knee arthroscopy was far less than previously experienced by our group, even in the placebo group. As a result, with very specific and standardized patient education, we have significantly decreased the amount of opioids that these patients are utilizing and prescribed, leading to less opioid consumption and unused pills in the community.