Study Finds Perineural Dexamethasone May Delay Nerve Recovery After Surgery, Urges Caution for High-Risk Patients

"Perineural dexamethasone could hinder nerve function recovery, indicating the need for caution, especially in patients with pre-existing nerve damage or diabetes," the researchers wrote.

Perineural dexamethasone, a corticosteroid administered near nerves to alleviate inflammation and pain, is often used in surgical settings to enhance recovery and minimize postoperative discomfort. Although many studies have explored how perineural dexamethasone affects nerve block duration, its potential effects on postoperative nerve injury have not been thoroughly investigated. Considering this, Yunke Dai, Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China, and colleagues aimed to clarify the impact of perineural dexamethasone on nerve injury and the recovery of nerve function following surgery.

The study, a prospective randomized double-blinded trial, was conducted at The First Affiliated Hospital of Chengdu Medical College in Chengdu, China, from June 14 to December 30, 2022. It involved patients aged 18 to 80 years, classified as ASA I or II, who were scheduled for elective orthopedic, burn, or plastic surgery. Participants were randomly assigned to receive either perineural dexamethasone (D group) or no dexamethasone (ND group).

The primary outcomes measured were the incidence and recovery of nerve injury, while secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events.

The researchers reported the following findings:

• Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %).
• At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % versus 60.3 %; OR = 2.45).
• There were no significant differences in postoperative hyperglycemia or surgical site infection rates.

The study revealed that perineural dexamethasone did not increase the initial risk of postoperative nerve injury but seemed to delay recovery from nerve injury symptoms. The researchers suggest weighing the advantages of prolonged analgesia and reduced postoperative nausea against this potential delay. Diabetes and tourniquet use were identified as significant risk factors, necessitating extra caution in these patients.

"These findings underscore the need for careful use of dexamethasone in high-risk individuals. Future research should focus on optimizing dosing, exploring alternative administration methods, and conducting longer-term studies to better understand the impact of dexamethasone on nerve recovery," the researchers concluded.

Reference:

Zhu, N., Xiang, B., Shi, J., Yang, P., Dai, Y., & Wang, S. (2024). The effect of perineural dexamethasone on nerve injury and recovery of nerve function after surgery: A randomized controlled trial. Heliyon, 10(16), e35612. https://doi.org/10.1016/j.heliyon.2024.e35612