Effect of intravenous dexamethasone on duration of analgesia following popliteal nerve block in pediatric ankle surgery: A randomized, triple-blinded clinical trial.

Summary

In a triple-blind RCT of 90 children undergoing foot/ankle surgery, IV dexamethasone 0.1 or 0.2 mg/kg given before a popliteal block significantly prolonged opioid-free time versus placebo, reduced opioid use (greatest at 0.2 mg/kg), and lowered pain/inflammatory markers. Trade-offs included dose-dependent hyperglycemia and delayed motor recovery.

Key Findings

• Both 0.1 and 0.2 mg/kg IV dexamethasone significantly prolonged opioid-free intervals versus placebo (≈12–14 h vs 7.5 h; p < 0.0001).
• Total opioid consumption was lowest in the 0.2 mg/kg group (p = 0.0292).
• Pain scores (FLACC) and inflammatory markers (NLR, PLR) were reduced in dexamethasone groups, with dose-dependent increases in blood glucose and delayed motor recovery.

Clinical Implications

Consider IV dexamethasone as an adjuvant to prolong popliteal block analgesia in pediatric foot/ankle surgery; 0.2 mg/kg maximizes benefit but may increase hyperglycemia and delay motor recovery—0.1 mg/kg may balance efficacy and metabolic safety. Monitor glucose and counsel about transient motor weakness.

Limitations

• Single-center study with modest sample size (n=90)
• Short-term outcomes only; metabolic effects beyond immediate postoperative period not assessed

Future Directions

Confirm efficacy and safety in multicenter trials, evaluate optimal dosing in specific comorbidities (e.g., diabetes), and assess long-term neurobehavioral outcomes.