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• W3097246561 endingPage "990" @default.
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• W3097246561 abstract "Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366–435) min, motor block duration of 369 (330–408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160–795) min], followed by perineural dexamethasone [411 (343–480) min] and perineural dexmedetomidine [284 (235–333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236–352) min], followed by intravenous dexamethasone [289 (129–448)min] and perineural dexmedetomidine [258 (212–304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448–589) min], followed by intravenous dexamethasone [478 (277–679) min] and perineural dexmedetomidine [318 (266–371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics." @default.
• W3097246561 created "2020-11-09" @default.
• W3097246561 creator A5012971967 @default.
• W3097246561 creator A5019776029 @default.
• W3097246561 creator A5033990372 @default.
• W3097246561 creator A5046694154 @default.
• W3097246561 creator A5047588221 @default.
• W3097246561 creator A5048243677 @default.
• W3097246561 creator A5048998547 @default.
• W3097246561 creator A5051739463 @default.
• W3097246561 date "2020-10-28" @default.
• W3097246561 modified "2023-09-23" @default.
• W3097246561 title "Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block" @default.
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