The Best Route And Dose Of Dexamethasone For Brachial Plexus Block:A Systematic Review And Meta-analysis

Background: Dexamethasone has been widely used in brachial plexus block to enhance the block effect,but the best way(perineural or intravenous)and dose are still inconclusive.Objective : To systematically evaluate The optimal approach and dose of dexamethasone for brachial plexus block.Methods :Studies on dexamethasone and brachial plexus block were searched by PubMed,Embase,Cochrane Library,CNKI,WanFang and VIP.Two evaluators analyzed the literatures,evaluated the quality,extracted relevant research indicators according to the screening criteria,and completed the meta-analysis.Results:A total of 16 articles were finally included in the meta-analysis(1260patients).As the results of Meta-analysis suggested,Regardless of the dose of 1-4 mg or 5-10 mg of dexamethasone,the perineural group significantly prolonged the duration of analgesia compared with the intravenous group[WMD=201.38,95%CI(68.22,334.54),P=0.003;WMD=302.96,95%CI(142.41,463.50),P=0.0002] ? There were no significant differences in the duration of motor block between the perineural group and the intravenous group[WMD=121.06,95%CI(-62.31,304.42),P=0.20] ?Conclusion:Dexamethasone combined with local anesthetics was used in brachial plexus block.Compared with the venous group,the peripheral nerve group significantly prolonged the duration of analgesia.However,compared with 1-4 mg,dexamethasone 5-10 mg had similar duration of analgesia and did not increase with the increase of dose.There were no significant differences in the duration of motor block between the perineural group and the intravenous group.