Dexamethasone as an adjuvant to peripheral nerve block

Carolyne Pehora; Annabel ME Pearson; Alka Kaushal; Mark W Crawford; Bradley Johnston

doi:10.1002/14651858.CD011770.pub2

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Figure 1

Flow diagram of included studies.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Forest plot of comparison: 1 Duration of sensory block: perineural dexamethasone versus placebo, outcome: 1.1 Duration of sensory block [hours].

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Figure 5

Forest plot of comparison: 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, outcome: 4.1 Postoperative pain intensity at12 hours.

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Figure 6

Forest plot of comparison: 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, outcome: 5.1 Postoperative pain intensity at 24 hours.

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Figure 7

Forest plot of comparison: 9 Duration of sensory block: intravenous dexamethasone versus placebo , outcome: 9.1 Duration of sensory block.

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Figure 8

Forest plot of comparison: 12 Postoperative pain intensity at 12 hours: intravenous dexamethasone versus placebo, outcome: 12.1 Postoperative pain intensity at 12 hours.

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Figure 9

Forest plot of comparison: 13 Postoperative pain intensity at 24 hours: intravenous dexamethasone versus placebo, outcome: 13.1 Postoperative pain intensity at 24 hours.

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Analysis 1.1

Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 1 Duration of sensory block.

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Analysis 1.2

Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 2 Duration of sensory block: long‐ versus medium‐acting local anaesthetic subgroups.

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Analysis 1.3

Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 3 Duration of sensory block: additive versus no additive subgroups.

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Analysis 1.4

Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 4 Duration of sensory block: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 1.5

Comparison 1 Duration of sensory block: perineural dexamethasone versus placebo, Outcome 5 Duration of sensory block: high/unclear versus low risk of bias subgroups.

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Analysis 2.1

Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 1 Duration of motor block.

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Analysis 2.2

Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 2 Duration of motor block: long‐ versus medium‐acting local anaesthetic subgroups.

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Analysis 2.3

Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 3 Duration of motor block: additives verus no additives subgroups.

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Analysis 2.4

Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 4 Duration of motor block: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 2.5

Comparison 2 Duration of motor block: perineural dexamethasone versus placebo, Outcome 5 Duration of motor block: high/unclear versus low risk of bias subgroups.

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Analysis 3.1

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 1 Overall incidence of block‐related adverse events.

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Analysis 3.2

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 2 Numbness/tingling 14 days after surgery.

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Analysis 3.3

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 3 Residual motor block/weakness 24 hours after surgery.

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Analysis 3.4

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 4 Horner Syndrome.

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Analysis 3.5

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 5 Hoarseness.

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Analysis 3.6

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 6 Diaphragmatic paresis.

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Analysis 3.7

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 7 Dyspnoea.

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Analysis 3.8

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 8 Vascular injury.

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Analysis 3.9

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 9 Cranial nerve 12 palsy.

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Analysis 3.10

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 10 Bruising.

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Analysis 3.11

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 11 Overall non‐block‐related adverse events.

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Analysis 3.12

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 12 Postoperative nausea and vomiting.

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Analysis 3.13

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 13 Deep sedation.

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Analysis 3.14

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 14 Dermatological symptoms (pruritus/rash).

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Analysis 3.15

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 15 Syncope/fainting.

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Analysis 3.16

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 16 Bradycardia.

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Analysis 3.17

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 17 Hypotension.

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Analysis 3.18

Comparison 3 Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo, Outcome 18 Headache/10‐pound fluid gain/diarrhoea/frequent urination/muscle soreness.

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Analysis 4.1

Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at12 hours.

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Analysis 4.2

Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 12 hours: medium‐ versus long‐acting local anaesthetic subgroups.

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Analysis 4.3

Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 12 hours: additive versus no additive subgroups.

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Analysis 4.4

Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 4 Postoperative pain intensity at 12 hours: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 4.5

Comparison 4 Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo, Outcome 5 Postoperative pain intensity at 12 hours: high/unclear versus low risk of bias subgroups.

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Analysis 5.1

Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at 24 hours.

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Analysis 5.2

Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 24 hours: long‐ versus medium‐acting local anaesthetic subgroups.

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Analysis 5.3

Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 24 hours: additive versus no additive subgroups.

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Analysis 5.4

Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 4 Postoperative pain intensity at 24 hours: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 5.5

Comparison 5 Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo, Outcome 5 Postoperative pain intensity at 24 hours: high/unclear versus low risk of bias subgroups.

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Analysis 6.1

Comparison 6 Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at 48 hours.

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Analysis 6.2

Comparison 6 Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 48 hours: additives versus no additives subgroups.

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Analysis 6.3

Comparison 6 Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 48 hours: high/unclear versus low risk of bias subgroups.

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Analysis 7.1

Comparison 7 Postoperative opioid consumption at 24 hours: perineural dexamethasone versus placebo, Outcome 1 Postoperative opioid consumption at 24 hours.

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Analysis 7.2

Comparison 7 Postoperative opioid consumption at 24 hours: perineural dexamethasone versus placebo, Outcome 2 Opioid consumption at 24 hours medium‐ versus long‐acting local anaesthetic subgroups.

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Analysis 7.3

Comparison 7 Postoperative opioid consumption at 24 hours: perineural dexamethasone versus placebo, Outcome 3 Opioid consumption at 24 hours: additive versus no additive subgroups.

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Analysis 7.4

Comparison 7 Postoperative opioid consumption at 24 hours: perineural dexamethasone versus placebo, Outcome 4 Opioid consumption at 24 hours: high/unclear versus low risk of bias subgroups.

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Analysis 8.1

Comparison 8 Participant satisfaction with pain control; perineural dexamethasone versus placebo, Outcome 1 Participant satisfaction with pain control: perineural dexamethasone versus placebo.

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Analysis 9.1

Comparison 9 Duration of sensory block: intravenous dexamethasone versus placebo, Outcome 1 Duration of sensory block.

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Analysis 9.2

Comparison 9 Duration of sensory block: intravenous dexamethasone versus placebo, Outcome 2 Duration sensory block: additive versus no additive subgroups.

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Analysis 9.3

Comparison 9 Duration of sensory block: intravenous dexamethasone versus placebo, Outcome 3 Duration of sensory block: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 9.4

Comparison 9 Duration of sensory block: intravenous dexamethasone versus placebo, Outcome 4 Duration of sensory block: high/unclear versus low risk of bias subgroups.

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Analysis 10.1

Comparison 10 Duration of motor block: intravenous dexamethasone versus placebo, Outcome 1 Duration of motor block.

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Analysis 10.2

Comparison 10 Duration of motor block: intravenous dexamethasone versus placebo, Outcome 2 Duration of motor block: additive versus no additive subgroups.

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Analysis 10.3

Comparison 10 Duration of motor block: intravenous dexamethasone versus placebo, Outcome 3 Duration of motor block high‐ versus low‐dose dexamethasone subgroups.

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Analysis 10.4

Comparison 10 Duration of motor block: intravenous dexamethasone versus placebo, Outcome 4 Duration of motor block: high/unclear versus low risk of bias subgroups.

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Analysis 11.1

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 1 Overall incidence of block‐related adverse events.

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Analysis 11.2

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 2 Numbness/tingling 14 days after surgery.

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Analysis 11.3

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 3 Residual motor block/muscle weakness 24 hours after surgery.

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Analysis 11.4

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 4 Horner syndrome.

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Analysis 11.5

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 5 Hoarsenss.

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Analysis 11.6

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 6 Dyspnoea.

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Analysis 11.7

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 7 Cranial nerve 12 palsy.

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Analysis 11.8

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 8 Overall non‐block‐related adverse events.

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Analysis 11.9

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 9 Postoperative nausea and vomiting.

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Analysis 11.10

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 10 Dermatological symptoms.

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Analysis 11.11

Comparison 11 Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo, Outcome 11 Dizziness/wrist, hand or finger pain, constipation.

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Analysis 12.1

Comparison 12 Postoperative pain intensity at 12 hours: intravenous dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at 12 hours.

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Analysis 12.2

Comparison 12 Postoperative pain intensity at 12 hours: intravenous dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 12 hours: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 12.3

Comparison 12 Postoperative pain intensity at 12 hours: intravenous dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 12 hours: high/unclear versus low risk of bias subgroups.

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Analysis 13.1

Comparison 13 Postoperative pain intensity at 24 hours: intravenous dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at 24 hours.

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Analysis 13.2

Comparison 13 Postoperative pain intensity at 24 hours: intravenous dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 24 hours: additive versus no additive subgroups.

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Analysis 13.3

Comparison 13 Postoperative pain intensity at 24 hours: intravenous dexamethasone versus placebo, Outcome 3 Postoperative pain intensity at 24 hours: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 13.4

Comparison 13 Postoperative pain intensity at 24 hours: intravenous dexamethasone versus placebo, Outcome 4 Postoperative pain intensity at 24 hours: high/unclear versus low risk of bias subgroups.

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Analysis 14.1

Comparison 14 Postoperative pain intensity at 48 hours: intravenous dexamethasone versus placebo, Outcome 1 Postoperative pain intensity at 48 hours.

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Analysis 14.2

Comparison 14 Postoperative pain intensity at 48 hours: intravenous dexamethasone versus placebo, Outcome 2 Postoperative pain intensity at 48 hours: additive versus no additive subgroups.

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Analysis 15.1

Comparison 15 Postoperative opioid consumption at 24 hours: intravenous dexamethasone versus placebo, Outcome 1 24‐hour opioid consumption.

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Analysis 15.2

Comparison 15 Postoperative opioid consumption at 24 hours: intravenous dexamethasone versus placebo, Outcome 2 24‐hour opioid consumption: additive verus no additive subgroups.

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Analysis 16.1

Comparison 16 Postoperative opioid consumption at 48 hours: intravenous dexamethasone versus placebo, Outcome 1 Postoperative opioid consumption at 48 hours opioid consumption.

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Analysis 17.1

Comparison 17 Participant satisfaction with pain control: intravenous dexamethasone versus placebo, Outcome 1 Participant satisfaction with pain control.

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Analysis 18.1

Comparison 18 Duration of sensory block: perineural versus intravenous dexamethasone, Outcome 1 Duration of sensory block.

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Analysis 18.2

Comparison 18 Duration of sensory block: perineural versus intravenous dexamethasone, Outcome 2 Duration of sensory block additive versus no additive subgroups.

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Analysis 18.3

Comparison 18 Duration of sensory block: perineural versus intravenous dexamethasone, Outcome 3 Duration sensory block high‐dose versus low‐dose dexamethasone subgroups.

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Analysis 18.4

Comparison 18 Duration of sensory block: perineural versus intravenous dexamethasone, Outcome 4 Duration sensory block high/unclear versus low risk of bias subgroups.

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Analysis 19.1

Comparison 19 Duration of motor block: perineural versus intravenous dexamethasone, Outcome 1 Duration of motor block.

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Analysis 19.2

Comparison 19 Duration of motor block: perineural versus intravenous dexamethasone, Outcome 2 Duration of motor block: additive versus no additive subgroups.

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Analysis 19.3

Comparison 19 Duration of motor block: perineural versus intravenous dexamethasone, Outcome 3 Duration of motor block: high‐ versus low‐dose dexamethasone subgroups.

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Analysis 19.4

Comparison 19 Duration of motor block: perineural versus intravenous dexamethasone, Outcome 4 Duration of motor block: high/unclear versus low risk of bias subgroups.

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Analysis 20.1

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 1 Overall incidence of block‐related adverse events.

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Analysis 20.2

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 2 Numbness/tingling 14 days after surgery.

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Analysis 20.3

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 3 Residual motor block/weakness at 24 hours.

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Analysis 20.4

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 4 Horner syndrome.

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Analysis 20.5

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 5 Hoarsness.

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Analysis 20.6

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 6 Cranial nerve 12 motor palsy.

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Analysis 20.7

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 7 Overall incidence of non block‐related adverse events.

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Analysis 20.8

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 8 Postoperative nausea and vomiting.

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Analysis 20.9

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 9 Dermatologicial symptoms (pruritus/rash).

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Analysis 20.10

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 10 Syncope/fainting.

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Analysis 20.11

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 11 Dizziness.

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Analysis 20.12

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 12 Wrist, hand or finger pain.

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Analysis 20.13

Comparison 20 Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone, Outcome 13 Headache, 10‐pound fluid gain/diarrhoea/frequent urination/ muscle soreness.

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Analysis 21.1

Comparison 21 Postoperative pain intensity at 12 hours: perineural versus intravenous dexamethasone, Outcome 1 Postoperative pain intensity at 12 hours.

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Analysis 21.2

Comparison 21 Postoperative pain intensity at 12 hours: perineural versus intravenous dexamethasone, Outcome 2 Postoperative pain intensity at 12 hours: low‐ versus high‐dose dexamethasone subgroups.

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Analysis 21.3

Comparison 21 Postoperative pain intensity at 12 hours: perineural versus intravenous dexamethasone, Outcome 3 Postoperative pain intensity at 12 hours: high/unclear versus low risk of bias subgroups.

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Analysis 22.1

Comparison 22 Postoperative pain intensity at 24 hours: perineural versus intravenous dexamethasone, Outcome 1 Postoperative pain intensity at 24 hours.

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Analysis 22.2

Comparison 22 Postoperative pain intensity at 24 hours: perineural versus intravenous dexamethasone, Outcome 2 Postoperative pain intensity at 24 hours: additive versus no additive subgroups.

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Analysis 22.3

Comparison 22 Postoperative pain intensity at 24 hours: perineural versus intravenous dexamethasone, Outcome 3 Postoperative pain intensity at 24 hours: low‐ versus high‐dose dexamethasonesubgroups.

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Analysis 22.4

Comparison 22 Postoperative pain intensity at 24 hours: perineural versus intravenous dexamethasone, Outcome 4 Intensity of postoperative pain at 24 hours: high/unclear risk of bias versus low risk of bias subgroups.

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Analysis 23.1

Comparison 23 Postoperative pain intensity at 48 hours: perineural versus intravenous dexamethasone, Outcome 1 Postoperative pain intensity at 48 hours.

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Analysis 23.2

Comparison 23 Postoperative pain intensity at 48 hours: perineural versus intravenous dexamethasone, Outcome 2 Postoperative pain intensity at 48 hours: additive versus no additive subgroups.

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Analysis 23.3

Comparison 23 Postoperative pain intensity at 48 hours: perineural versus intravenous dexamethasone, Outcome 3 Postoperative pain intensity at 48 hours: low‐ versus high‐dose dexamethasone subgroups.

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Analysis 23.4

Comparison 23 Postoperative pain intensity at 48 hours: perineural versus intravenous dexamethasone, Outcome 4 Postoperative pain intensity at 48 hours: high/unclear versus low risk of bias subgroups.

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Analysis 24.1

Comparison 24 Postoperative opioid consumption at 24 hours: perineural versus intravenous dexamethasone opioid consumption: perineural versus intravenous dexamethasone subgroups, Outcome 1 Opioid consumption at 24 hours: perineural versus intravenous dexamethasone.

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Analysis 24.2

Comparison 24 Postoperative opioid consumption at 24 hours: perineural versus intravenous dexamethasone opioid consumption: perineural versus intravenous dexamethasone subgroups, Outcome 2 24‐hour opioid consumption: additive versus no additive subgroups.

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Analysis 25.1

Comparison 25 Participant satisfaction with pain control: perineural versus intravenous dexamethasone, Outcome 1 Participant satisfaction with pain control.

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Summary of findings for the main comparison. Perineural dexamethasone versus placebo

Patient or population: participants undergoing surgery with peripheral nerve block Setting: participants undergoing upper and lower limb surgery in hospitals in Australia, Bangledesh, Belgium, Brazil, India, Iran, Japan, Korea, Nepal, Turkey and USA Intervention: perineural dexamethasone Comparison: placebo
Outcomes	Anticipated absolute effects^* (95% CI)		№ of participants (studies)	Quality of the evidence (GRADE)
Outcomes	Risk with placebo	Risk with perineural dexamethasone	№ of participants (studies)	Quality of the evidence (GRADE)
Duration of sensory block (we included all studies describing duration of sensory block, regardless of how it was described)	The mean duration of sensory block was 10.2 hours	The mean duration of sensory block in the perineural dexamethasone group was 6.70 hours longer (5.54 longer to 7.85 longer)	1625 (27 RCTs)	⨁⨁◯◯ LOW ^a
Incidence of serious adverse events (we used the NIH definition of adverse events. A serious event includes death, a life‐threatening event that requires hospitalization or prolonged hospitalization, disability or congenital anomaly)	In seven studies, authors reported that they assessed for serious adverse events. Five serious adverse events were reported in three studies: one block‐related adverse event (pneumothorax) occurred in one participant in a trial comparing perineural dexamethasone and placebo; however, group allocation was not reported. The remaining non‐block‐related events occurred in two trials comparing perineural dexamethasone, intravenous dexamethasone and placebo. Two participants in the placebo group required hospitalization within one week of surgery; one for a fall, and one for a bowel infection. One participant in the placebo group developed Complex Regional Pain Syndrome Type I and one in the intravenous dexamethasone group developed pneumonia.		620 (7 RCTs)	⨁◯◯◯ VERY LOW^b
Postoperative pain intensity at 12 hours (assessed by pain scores on an 11‐point VAS)	The mean postoperative pain intensity at 12 hours was 3.0	The mean postoperative pain score at 12 hours in the perineural dexamethasone group was 2.08 points lower (1.52 lower to 2.63 lower)	257 (5 RCTs)	⨁◯◯◯ VERY LOW^c
Postoperative pain intensity at 24 hours. (assessed by pain scores on an 11‐point VAS)	The mean postoperative pain intensity at 24 hours was 3.9	The mean postoperative pain score at 24 hours in the perineural dexamethasone group was 1.63 points lower (0.93 lower to 2.34 lower)	469 (9 RCTs)	⨁⨁◯◯ LOW ^d
Postoperative pain intensity at 48 hours (assessed by pain scores on an 11‐point VAS)	The mean postoperative pain intensity at 48 hours was 3.3	The mean postoperative pain score at 48 hours in the perineural dexamethasone group was 0.61 points lower (1.24 lower to 0.03 higher)	296 (3 RCTs)	⨁⨁◯◯ LOW ^e
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean difference; NIH: National Institute of Health; RCT: randomized controlled trial; VAS: Visual Analogue Scale.
GRADE Working Group grades of evidence High‐quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate‐quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low‐quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low‐quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded by one level for risk of bias as 19 out of 27 studies are at unclear risk of bias. Reasons include lack of reporting on random sequence generation, concealment allocation, blinding, and attrition bias. Downgraded by one level for inconsistency (I² = 99%, P value for heterogeneity is < 0.00001) and heterogeneity is not explained by subgroup analyses; point estimates vary widely among studies, confidence intervals show minimal overlap). ^bDowngraded by one level for risk of bias as four out of the seven studies are at unclear risk of bias. Reasons include lack of reporting on random sequence generation, concealment allocation, blinding, and evidence of selective reporting bias. Downgraded by two levels for imprecision due to very low number of events. ^c Downgraded by one level for risk of bias. Three out of five studies are at unclear risk of bias. Reasons include lack of reporting on random sequence generation and allocation concealment and evidence of attrition bias, selective reporting bias, and stopping early for benefit. Downgraded by one level for inconsistency (I² = 61%, P value for heterogeneity is 0.03) and heterogeneity is not explained by subgroup analyses; point estimates vary widely among studies, confidence intervals show minimal overlap ^dDowngraded by one level for inconsistency (I² = 80%, P value for heterogeneity is < 0.00001) and heterogeneity is not explained by subgroup analyses; point estimates vary widely across studies. Downgraded by one level for imprecision (95% confidence interval includes no clinical effect and a clinical effect). By no clinical effect we mean the lower bound of the CI did not surpass our chosen MID threshold of 1.2 on VAS. ^e Downgraded by two levels for imprecision because of a sparse number of participants (n=296) and a very wide confidence interval demonstrating that the treatment effect is not statistically significant and of questionable clinical significance.

Summary of findings for the main comparison. Perineural dexamethasone versus placebo

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Summary of findings 2. Intravenous dexamethasone versus placebo

Patient or population: participants undergoing surgery with peripheral nerve block Setting: participants undergoing upper and lower limb surgery in hospitals in Australia, Belgium, Brazil, Canada, Japan, Korea, Thailand and USA Intervention: intravenous dexamethasone Comparison: placebo
Outcomes	Anticipated absolute effects^* (95% CI)		№ of participants (studies)	Quality of the evidence (GRADE)
Outcomes	Risk with placebo	Risk with intravenous dexamethasone	№ of participants (studies)	Quality of the evidence (GRADE)
Duration of sensory block (we included all studies describing duration of sensory block regardless of how it was described)	The mean duration of sensory block was 16.1 hours	The mean duration of sensory block in the intravenous dexamethasone group was 6.21 hours longer (3.53 longer to 8.88 longer)	499 (8 RCTs)	⨁⨁⨁◯ MODERATE ^a
Incidence of serious adverse events (we used the NIH definition of adverse events. A serious event includes death, a life‐threatening event that requires hospitalization or prolonged hospitalization, disability or congenital anomaly)	Please see incidence of serious adverse events in the perineural dexamethasone versus placebo 'Summary of findings' table.
Postoperative pain intensity at 12 hours (measured using pain scores on an 11‐point VAS)	The mean postoperative pain score at 12 hours was 2.6	The mean postoperative pain score at 12 hours in the intravenous dexamethasone group was 1.24 points lower (2.44 lower to 0.04 lower)	162 (3 RCTs)	⨁⨁◯◯ LOW ^b
Postoperative pain intensity at 24 hours (measured using pain scores on an 11‐point VAS)	The mean postoperative pain score at 24 hours was 4.4	The mean postoperative pain score at 24 hours in the intravenous dexamethasone group was 1.26 points lower (2.23 lower to 0.29 lower)	257 (5 RCTs)	⨁⨁◯◯ LOW ^c
Postoperative pain intensity at 48 hours (measured using pain scores on an 11‐point VAS)	The mean postoperative pain score at 48 hours was 3.7	The mean postoperative pain score at 48 hours in the intravenous dexamethasone group was 0.21 points lower (0.83 lower to 0.41 higher)	172 (3 RCTs)	⨁⨁◯◯ LOW ^d
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean difference; NIH: National Institute of Health; RCT: randomized controlled trial; VAS: Visual Analogue Scale.
GRADE Working Group grades of evidence High‐quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate‐quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low‐quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low‐quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded by one level for inconsistency (considerable heterogeneity (I² = 88% and P value for heterogeneity <0.0001) and subgroup analyses did not explain observed heterogeneity. Downgraded by one level for imprecision because of a sparse number of participants (n=162). ^bDowngraded by one level for inconsistency (I² = 61% and P value for heterogeneity 0.08) and subgroup analyses did not explain observed heterogeneity. Downgraded by one level for imprecision. Confidence interval includes both no clinical effect (minimally important difference 1.2 on VAS) and clinical effect (minimally important difference greater than 1.2 on VAS). ^cDowngraded by one level for inconsistency(I² = 65% and P value for heterogeneity 0.02) and subgroup analyses did not explain observed heterogeneity. Point estimates vary widely across studies. Downgraded by one level for imprecision (95% confidence interval includes no clinical effect and a clinical effect). By no clinical effect we mean the lower bound of the CI did not surpass our chosen MID threshold of 1.2 on VAS. ^dDowngraded by two levels for precision (small sample size (n=172) and confidence interval crosses the line of null effect)..

Summary of findings 2. Intravenous dexamethasone versus placebo

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Summary of findings 3. Perineural versus intravenous dexamethasone

Patient or population: peripheral nerve block Setting: people undergoing upper or lower limb surgery with peripheral nerve block in hospitals in Australia, Belgium, Brazil, Canada and USA Intervention: perineural dexamethasone Comparison: intravenous dexamethasone
Outcomes	Anticipated absolute effects^* (95% CI)		№ of participants (studies)	Quality of the evidence (GRADE)
Outcomes	Risk with intravenous dexamethasone	Risk with perineural dexamethasone	№ of participants (studies)	Quality of the evidence (GRADE)
Duration of sensory block (we included all studies describing duration of sensory block regardless of how it was described)	The mean duration of sensory block was 20.6 hours	The mean duration of sensory block in the perineural dexamethasone group was 3.13 hours longer (1.68 longer to 4.58 longer)	720 (9 RCTs)	⨁⨁⨁◯ MODERATE ^a
Incidence of serious adverse events (we used the NIH definition of adverse events. A serious event includes death, a life‐threatening event that requires hospitalization or prolonged hospitalization, disability or congenital anomaly)	Please see incidence of serious adverse events in the perineural dexamethasone versus placebo 'Summary of findings' table.
Postoperative pain intensity at 12 hours (measured using pain scores on an 11‐point VAS)	The mean postoperative pain score at 12 hours was 2.3	The mean postoperative pain score at 12 hours in the perineural dexamethasone group was 1.01 points lower (0.50 lower to 1.51 lower)	217 (3 RCTs)	⨁⨁◯◯ LOW ^b
Postoperative pain intensity at 24 hours (measured using pain scores on an 11‐point VAS)	The mean postoperative pain score at 24 hours was 2.9	The mean postoperative pain score at 24 hours in the perineural dexamethasone group was 0.77 points lower (0.08 lower to 1.47 lower)	309 (5 RCTs)	⨁⨁⨁◯ MODERATE ^c
Postoperative pain intensity at 48 hours (measured using pain scores on an 11‐point VAS)	The mean postoperative pain score at 48 hours was 2.8	The mean postoperative pain score at 48 hours in the perineural dexamethasone group was 0.13 points higher (0.35 lower to 0.61 higher)	227 (3 RCTs)	⨁⨁◯◯ LOW ^d
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean difference; NIH: National Institute of Health; RCT: randomized controlled trial; VAS: Visual Analogue Scale.
GRADE Working Group grades of evidence High‐quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate‐quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low‐quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low‐quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^aDowngraded by one level for inconsistency (I² = 67% and P value for heterogeneity is 0.001). ^bDowngraded by one level for risk of bias. Two out of the three studies are at unclear risk of bias. Reasons include unclear random sequence generation, unclear allocation concealment, and selective outcome reporting. Downgraded by one level for imprecision because of a sparse number of participants (n=217) and because the 95% confidence interval includes no clinical effect and a clinical effect. By no clinical effect we mean the lower bound of the CI did not surpass our chosen MID threshold of 1.2 on VAS. ^cDowngraded by one level for imprecision (95% confidence interval includes no clinical effect and a clinical effect). By no clinical effect we mean the lower bound of the CI did not surpass our chosen MID threshold of 1.2 on VAS. ^dDowngraded by one level for risk of bias. The one study that is at unclear risk of bias contributes half the data for this outcome. Downgraded by one level for imprecision because of a small sample size (n=227).

Summary of findings 3. Perineural versus intravenous dexamethasone

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Comparison 1. Duration of sensory block: perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of sensory block Show forest plot	27	1625	Mean Difference (IV, Random, 95% CI)	6.70 [5.54, 7.85]

2 Duration of sensory block: long‐ versus medium‐acting local anaesthetic subgroups Show forest plot	26	1572	Mean Difference (IV, Random, 95% CI)	6.78 [5.62, 7.94]

2.1 Long‐acting local anaesthetic	20	1315	Mean Difference (IV, Random, 95% CI)	7.81 [6.40, 9.21]
2.2 Medium‐acting local anaesthetic	6	257	Mean Difference (IV, Random, 95% CI)	3.98 [1.76, 6.20]
3 Duration of sensory block: additive versus no additive subgroups Show forest plot	27	1625	Mean Difference (IV, Random, 95% CI)	6.70 [5.54, 7.85]

3.1 Additives	6	336	Mean Difference (IV, Random, 95% CI)	7.29 [3.77, 10.81]
3.2 No additives	21	1289	Mean Difference (IV, Random, 95% CI)	6.60 [5.30, 7.89]
4 Duration of sensory block: high‐ versus low‐dose dexamethasone subgroups Show forest plot	27	1627	Mean Difference (IV, Random, 95% CI)	6.70 [5.53, 7.86]

4.1 High‐dose dexamethasone	23	1447	Mean Difference (IV, Random, 95% CI)	7.09 [5.81, 8.38]
4.2 Low‐dose dexamethasone	4	180	Mean Difference (IV, Random, 95% CI)	4.32 [1.80, 6.85]
5 Duration of sensory block: high/unclear versus low risk of bias subgroups Show forest plot	26	1625	Mean Difference (IV, Random, 95% CI)	6.70 [5.54, 7.85]

5.1 High or unclear risk of bias	19	1037	Mean Difference (IV, Random, 95% CI)	6.28 [5.01, 7.56]
5.2 Low risk of bias	8	588	Mean Difference (IV, Random, 95% CI)	8.21 [4.56, 11.85]

Comparison 1. Duration of sensory block: perineural dexamethasone versus placebo

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Comparison 2. Duration of motor block: perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of motor block Show forest plot	16	912	Mean Difference (IV, Random, 95% CI)	5.87 [4.44, 7.30]

2 Duration of motor block: long‐ versus medium‐acting local anaesthetic subgroups Show forest plot	16	912	Mean Difference (IV, Random, 95% CI)	5.87 [4.44, 7.30]

2.1 Long‐acting local anaesthetic	13	764	Mean Difference (IV, Random, 95% CI)	6.61 [4.58, 8.65]
2.2 Medium‐acting local anaesthetic	3	148	Mean Difference (IV, Random, 95% CI)	2.59 [2.42, 2.76]
3 Duration of motor block: additives verus no additives subgroups Show forest plot	16	912	Mean Difference (IV, Random, 95% CI)	5.87 [4.44, 7.30]

3.1 Additives	5	280	Mean Difference (IV, Random, 95% CI)	7.47 [3.58, 11.36]
3.2 No additives	11	632	Mean Difference (IV, Random, 95% CI)	5.26 [3.17, 7.35]
4 Duration of motor block: high‐ versus low‐dose dexamethasone subgroups Show forest plot	16	912	Mean Difference (IV, Random, 95% CI)	5.87 [4.44, 7.30]

4.1 High‐dose dexamethasone	15	872	Mean Difference (IV, Random, 95% CI)	5.75 [4.29, 7.22]
4.2 Low‐dose dexamethasone	1	40	Mean Difference (IV, Random, 95% CI)	8.1 [4.69, 11.51]
5 Duration of motor block: high/unclear versus low risk of bias subgroups Show forest plot	16	912	Mean Difference (IV, Random, 95% CI)	5.87 [4.44, 7.30]

5.1 High/unclear risk of bias	14	809	Mean Difference (IV, Random, 95% CI)	5.67 [4.18, 7.16]
5.2 Low risk of bias	2	103	Mean Difference (IV, Random, 95% CI)	7.93 [2.74, 13.13]

Comparison 2. Duration of motor block: perineural dexamethasone versus placebo

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Comparison 3. Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Overall incidence of block‐related adverse events Show forest plot	10	677	Risk Ratio (M‐H, Random, 95% CI)	1.17 [0.99, 1.39]

2 Numbness/tingling 14 days after surgery Show forest plot	5	323	Risk Ratio (M‐H, Random, 95% CI)	1.76 [0.80, 3.89]

3 Residual motor block/weakness 24 hours after surgery Show forest plot	3	259	Risk Ratio (M‐H, Random, 95% CI)	4.69 [0.57, 38.68]

4 Horner Syndrome Show forest plot	4	321	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.73, 1.36]

5 Hoarseness Show forest plot	4	353	Risk Ratio (M‐H, Random, 95% CI)	1.23 [0.65, 2.34]

6 Diaphragmatic paresis Show forest plot	2	172	Risk Ratio (M‐H, Random, 95% CI)	1.46 [0.66, 3.23]

7 Dyspnoea Show forest plot	4	274	Risk Ratio (M‐H, Random, 95% CI)	0.34 [0.01, 8.14]

8 Vascular injury Show forest plot	1	100	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.19, 21.36]

9 Cranial nerve 12 palsy Show forest plot	1	83	Risk Ratio (M‐H, Random, 95% CI)	0.33 [0.01, 7.77]

10 Bruising Show forest plot	1	37	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.07, 15.64]

11 Overall non‐block‐related adverse events Show forest plot	10	625	Risk Ratio (M‐H, Random, 95% CI)	0.76 [0.35, 1.68]

12 Postoperative nausea and vomiting Show forest plot	10	585	Risk Ratio (M‐H, Random, 95% CI)	0.55 [0.26, 1.14]

13 Deep sedation Show forest plot	1	60	Risk Ratio (M‐H, Random, 95% CI)	7.0 [0.38, 129.93]

14 Dermatological symptoms (pruritus/rash) Show forest plot	1	83	Risk Ratio (M‐H, Random, 95% CI)	2.93 [0.32, 27.02]

15 Syncope/fainting Show forest plot	1	83	Risk Ratio (M‐H, Random, 95% CI)	1.95 [0.18, 20.71]

16 Bradycardia Show forest plot	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.12, 3.71]

17 Hypotension Show forest plot	2	140	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.21, 2.13]

18 Headache/10‐pound fluid gain/diarrhoea/frequent urination/muscle soreness Show forest plot	1	83	Risk Ratio (M‐H, Random, 95% CI)	2.93 [0.12, 69.92]

Comparison 3. Incidence of mild to moderate adverse events: perineural dexamethasone versus placebo

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Comparison 4. Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at12 hours Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐2.08 [‐2.63, ‐1.52]

2 Postoperative pain intensity at 12 hours: medium‐ versus long‐acting local anaesthetic subgroups Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐2.08 [‐2.63, ‐1.53]

2.1 Long‐acting local anaesthesia	4	234	Mean Difference (IV, Random, 95% CI)	‐2.21 [‐2.77, ‐1.66]
2.2 Medium‐acting local anaesthesia	1	23	Mean Difference (IV, Random, 95% CI)	‐1.22 [‐2.38, ‐0.06]
3 Postoperative pain intensity at 12 hours: additive versus no additive subgroups Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐2.08 [‐2.63, ‐1.52]

3.1 Additives	1	23	Mean Difference (IV, Random, 95% CI)	‐1.20 [‐2.36, ‐0.04]
3.2 No additives	4	234	Mean Difference (IV, Random, 95% CI)	‐2.21 [‐2.77, ‐1.66]
4 Postoperative pain intensity at 12 hours: high‐ versus low‐dose dexamethasone subgroups Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐2.08 [‐2.63, ‐1.52]

4.1 High‐dose dexamethasone	3	177	Mean Difference (IV, Random, 95% CI)	‐2.17 [‐3.29, ‐1.06]
4.2 Low‐dose dexamethasone	2	80	Mean Difference (IV, Random, 95% CI)	‐1.99 [‐2.75, ‐1.22]
5 Postoperative pain intensity at 12 hours: high/unclear versus low risk of bias subgroups Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐2.08 [‐2.63, ‐1.52]

5.1 High/unclear versus low risk of bias	3	103	Mean Difference (IV, Random, 95% CI)	‐1.81 [‐2.53, ‐1.09]
5.2 Low risk of bias	2	154	Mean Difference (IV, Random, 95% CI)	‐2.61 [‐3.88, ‐1.34]

Comparison 4. Postoperative pain intensity at 12 hours: perineural dexamethasone versus placebo

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Comparison 5. Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 24 hours Show forest plot	9	469	Mean Difference (IV, Random, 95% CI)	‐1.63 [‐2.34, ‐0.93]

2 Postoperative pain intensity at 24 hours: long‐ versus medium‐acting local anaesthetic subgroups Show forest plot	9	469	Mean Difference (IV, Random, 95% CI)	‐1.63 [‐2.34, ‐0.93]

2.1 Long‐acting local anaesthesia	7	409	Mean Difference (IV, Random, 95% CI)	‐1.75 [‐2.60, ‐0.90]
2.2 Medium‐acting local anaesthesia	2	60	Mean Difference (IV, Random, 95% CI)	‐1.08 [‐2.07, ‐0.09]
3 Postoperative pain intensity at 24 hours: additive versus no additive subgroups Show forest plot	9	469	Mean Difference (IV, Random, 95% CI)	‐1.63 [‐2.34, ‐0.93]

3.1 Additives	3	158	Mean Difference (IV, Random, 95% CI)	‐2.13 [‐3.43, ‐0.82]
3.2 No additives	6	311	Mean Difference (IV, Random, 95% CI)	‐1.41 [‐2.31, ‐0.51]
4 Postoperative pain intensity at 24 hours: high‐ versus low‐dose dexamethasone subgroups Show forest plot	9	469	Mean Difference (IV, Random, 95% CI)	‐1.63 [‐2.34, ‐0.93]

4.1 High‐dose dexamethasone	7	389	Mean Difference (IV, Random, 95% CI)	‐1.59 [‐2.71, ‐0.47]
4.2 Low‐dose dexamethasone	2	80	Mean Difference (IV, Random, 95% CI)	‐1.87 [‐3.21, ‐0.52]
5 Postoperative pain intensity at 24 hours: high/unclear versus low risk of bias subgroups Show forest plot	9	469	Mean Difference (IV, Random, 95% CI)	‐1.63 [‐2.34, ‐0.93]

5.1 High/unclear risk of bias	4	185	Mean Difference (IV, Random, 95% CI)	‐1.90 [‐2.79, ‐1.00]
5.2 Low risk of bias	5	284	Mean Difference (IV, Random, 95% CI)	‐1.43 [‐2.91, 0.04]

Comparison 5. Postoperative pain intensity at 24 hours: perineural dexamethasone versus placebo

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Comparison 6. Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 48 hours Show forest plot	4	296	Mean Difference (IV, Random, 95% CI)	‐0.61 [‐1.24, 0.03]

2 Postoperative pain intensity at 48 hours: additives versus no additives subgroups Show forest plot	4	296	Mean Difference (IV, Random, 95% CI)	‐0.61 [‐1.24, 0.03]

2.1 No additives	2	155	Mean Difference (IV, Random, 95% CI)	‐0.86 [‐1.36, ‐0.36]
2.2 Additives	2	141	Mean Difference (IV, Random, 95% CI)	‐0.23 [‐1.80, 1.34]
3 Postoperative pain intensity at 48 hours: high/unclear versus low risk of bias subgroups Show forest plot	4	296	Mean Difference (IV, Random, 95% CI)	‐0.61 [‐1.24, 0.03]

3.1 High/unclear risk of bias	1	88	Mean Difference (IV, Random, 95% CI)	‐1.0 [‐2.24, 0.24]
3.2 Low risk of bias	3	208	Mean Difference (IV, Random, 95% CI)	‐0.45 [‐1.30, 0.40]

Comparison 6. Postoperative pain intensity at 48 hours: perineural dexamethasone versus placebo

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Comparison 7. Postoperative opioid consumption at 24 hours: perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative opioid consumption at 24 hours Show forest plot	6	380	Mean Difference (IV, Random, 95% CI)	‐19.25 [‐32.51, ‐5.99]

2 Opioid consumption at 24 hours medium‐ versus long‐acting local anaesthetic subgroups Show forest plot	6	380	Mean Difference (IV, Random, 95% CI)	‐19.25 [‐32.51, ‐5.99]

2.1 Long‐acting local anaesthetic	5	335	Mean Difference (IV, Random, 95% CI)	‐21.22 [‐35.20, ‐7.25]
2.2 Medium‐acting local anaesthetic	1	45	Mean Difference (IV, Random, 95% CI)	4.0 [‐33.91, 41.91]
3 Opioid consumption at 24 hours: additive versus no additive subgroups Show forest plot	6	380	Mean Difference (IV, Random, 95% CI)	‐19.25 [‐32.51, ‐5.99]

3.1 Additives	2	142	Mean Difference (IV, Random, 95% CI)	‐30.17 [‐58.58, ‐1.76]
3.2 No additives	4	238	Mean Difference (IV, Random, 95% CI)	‐12.98 [‐26.28, 0.32]
4 Opioid consumption at 24 hours: high/unclear versus low risk of bias subgroups Show forest plot	6	380	Mean Difference (IV, Random, 95% CI)	‐19.25 [‐32.51, ‐5.99]

4.1 High/unclear risk of bias	1	88	Mean Difference (IV, Random, 95% CI)	‐45.0 [‐57.58, ‐32.42]
4.2 Low risk of bias	5	292	Mean Difference (IV, Random, 95% CI)	‐13.55 [‐23.36, ‐3.75]

Comparison 7. Postoperative opioid consumption at 24 hours: perineural dexamethasone versus placebo

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Comparison 8. Participant satisfaction with pain control; perineural dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Participant satisfaction with pain control: perineural dexamethasone versus placebo Show forest plot	4	224	Mean Difference (IV, Random, 95% CI)	0.83 [‐0.05, 1.71]

Comparison 8. Participant satisfaction with pain control; perineural dexamethasone versus placebo

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Comparison 9. Duration of sensory block: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of sensory block Show forest plot	8	499	Mean Difference (IV, Random, 95% CI)	6.21 [3.53, 8.88]

2 Duration sensory block: additive versus no additive subgroups Show forest plot	8	499	Mean Difference (IV, Random, 95% CI)	6.21 [3.53, 8.88]

2.1 Additives	1	49	Mean Difference (IV, Random, 95% CI)	6.20 [0.68, 11.72]
2.2 No additives	7	450	Mean Difference (IV, Random, 95% CI)	6.21 [3.33, 9.08]
3 Duration of sensory block: high‐ versus low‐dose dexamethasone subgroups Show forest plot	8	499	Mean Difference (IV, Random, 95% CI)	6.21 [3.53, 8.88]

3.1 High‐dose	6	437	Mean Difference (IV, Random, 95% CI)	7.45 [5.55, 9.35]
3.2 Low‐dose	2	62	Mean Difference (IV, Random, 95% CI)	2.25 [1.21, 3.30]
4 Duration of sensory block: high/unclear versus low risk of bias subgroups Show forest plot	8	499	Mean Difference (IV, Random, 95% CI)	6.21 [3.53, 8.88]

4.1 High/unclear risk of bias	2	62	Mean Difference (IV, Random, 95% CI)	2.25 [1.21, 3.30]
4.2 Low risk of bias	6	437	Mean Difference (IV, Random, 95% CI)	7.45 [5.55, 9.35]

Comparison 9. Duration of sensory block: intravenous dexamethasone versus placebo

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Comparison 10. Duration of motor block: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of motor block Show forest plot	3	139	Mean Difference (IV, Random, 95% CI)	5.04 [3.07, 7.00]

2 Duration of motor block: additive versus no additive subgroups Show forest plot	3	139	Mean Difference (IV, Random, 95% CI)	5.54 [3.11, 7.97]

2.1 Additives	1	49	Mean Difference (IV, Random, 95% CI)	6.60 [2.32, 10.88]
2.2 No additives	2	90	Mean Difference (IV, Random, 95% CI)	3.67 [‐2.77, 10.11]
3 Duration of motor block high‐ versus low‐dose dexamethasone subgroups Show forest plot	3	139	Mean Difference (IV, Random, 95% CI)	5.04 [3.07, 7.00]

3.1 High‐dose dexamethasone	2	99	Mean Difference (IV, Random, 95% CI)	5.96 [4.03, 7.90]
3.2 Low‐dose dexamethasone	1	40	Mean Difference (IV, Random, 95% CI)	3.10 [0.23, 5.97]
4 Duration of motor block: high/unclear versus low risk of bias subgroups Show forest plot	3	139	Mean Difference (IV, Random, 95% CI)	5.04 [3.07, 7.00]

4.1 High/unclear risk of bias	2	99	Mean Difference (IV, Random, 95% CI)	5.96 [4.03, 7.90]
4.2 Low risk of bias	1	40	Mean Difference (IV, Random, 95% CI)	3.10 [0.23, 5.97]

Comparison 10. Duration of motor block: intravenous dexamethasone versus placebo

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Comparison 11. Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Overall incidence of block‐related adverse events Show forest plot	5	393	Risk Ratio (M‐H, Random, 95% CI)	1.09 [0.69, 1.70]

2 Numbness/tingling 14 days after surgery Show forest plot	2	101	Risk Ratio (M‐H, Random, 95% CI)	1.69 [0.31, 9.26]

3 Residual motor block/muscle weakness 24 hours after surgery Show forest plot	3	265	Risk Ratio (M‐H, Random, 95% CI)	2.68 [0.80, 8.90]

4 Horner syndrome Show forest plot	2	214	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.63, 1.26]

5 Hoarsenss Show forest plot	2	215	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.45, 1.71]

6 Dyspnoea Show forest plot	3	219	Risk Ratio (M‐H, Random, 95% CI)	0.63 [0.11, 3.74]

7 Cranial nerve 12 palsy Show forest plot	1	78	Risk Ratio (M‐H, Random, 95% CI)	0.37 [0.02, 8.77]

8 Overall non‐block‐related adverse events Show forest plot	5	258	Risk Ratio (M‐H, Random, 95% CI)	1.23 [0.38, 3.97]

9 Postoperative nausea and vomiting Show forest plot	3	134	Risk Ratio (M‐H, Random, 95% CI)	0.66 [0.12, 3.78]

10 Dermatological symptoms Show forest plot	2	124	Risk Ratio (M‐H, Random, 95% CI)	1.88 [0.09, 40.62]

11 Dizziness/wrist, hand or finger pain, constipation Show forest plot	1	78	Risk Ratio (M‐H, Random, 95% CI)	0.37 [0.02, 8.77]

Comparison 11. Incidence of mild to moderate adverse events: intravenous dexamethasone versus placebo

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Comparison 12. Postoperative pain intensity at 12 hours: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 12 hours Show forest plot	3	162	Mean Difference (IV, Random, 95% CI)	‐1.24 [‐2.44, ‐0.04]

2 Postoperative pain intensity at 12 hours: high‐ versus low‐dose dexamethasone subgroups Show forest plot	3	162	Mean Difference (IV, Random, 95% CI)	‐1.24 [‐2.44, ‐0.04]

2.1 High‐dose dexamethasone	2	122	Mean Difference (IV, Random, 95% CI)	‐1.80 [‐3.16, ‐0.44]
2.2 Low‐dose dexamethasone	1	40	Mean Difference (IV, Random, 95% CI)	‐0.5 [‐1.41, 0.41]
3 Postoperative pain intensity at 12 hours: high/unclear versus low risk of bias subgroups Show forest plot	3	162	Mean Difference (IV, Random, 95% CI)	‐1.24 [‐2.44, ‐0.04]

3.1 High/unclear risk of bias	1	40	Mean Difference (IV, Random, 95% CI)	‐0.5 [‐1.41, 0.41]
3.2 Low risk of bias	2	122	Mean Difference (IV, Random, 95% CI)	‐1.80 [‐3.16, ‐0.44]

Comparison 12. Postoperative pain intensity at 12 hours: intravenous dexamethasone versus placebo

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Comparison 13. Postoperative pain intensity at 24 hours: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 24 hours Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐1.26 [‐2.23, ‐0.29]

2 Postoperative pain intensity at 24 hours: additive versus no additive subgroups Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐1.26 [‐2.23, ‐0.29]

2.1 Additive	1	49	Mean Difference (IV, Random, 95% CI)	‐0.90 [‐2.75, 0.95]
2.2 No additive	4	208	Mean Difference (IV, Random, 95% CI)	‐1.33 [‐2.48, ‐0.18]
3 Postoperative pain intensity at 24 hours: high‐ versus low‐dose dexamethasone subgroups Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐1.26 [‐2.23, ‐0.29]

3.1 High‐dose dexamethasone	4	217	Mean Difference (IV, Random, 95% CI)	‐1.31 [‐2.54, ‐0.07]
3.2 Low‐dose dexamethasone	1	40	Mean Difference (IV, Random, 95% CI)	‐1.1 [‐2.49, 0.29]
4 Postoperative pain intensity at 24 hours: high/unclear versus low risk of bias subgroups Show forest plot	5	257	Mean Difference (IV, Random, 95% CI)	‐1.26 [‐2.23, ‐0.29]

4.1 High/unclear risk of bias	1	40	Mean Difference (IV, Random, 95% CI)	‐1.1 [‐2.49, 0.29]
4.2 Low risk of bias	4	217	Mean Difference (IV, Random, 95% CI)	‐1.31 [‐2.54, ‐0.07]

Comparison 13. Postoperative pain intensity at 24 hours: intravenous dexamethasone versus placebo

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Comparison 14. Postoperative pain intensity at 48 hours: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 48 hours Show forest plot	3	172	Mean Difference (IV, Random, 95% CI)	‐0.18 [‐0.80, 0.44]

2 Postoperative pain intensity at 48 hours: additive versus no additive subgroups Show forest plot	3	172	Mean Difference (IV, Random, 95% CI)	‐0.18 [‐0.80, 0.44]

2.1 Additive	1	49	Mean Difference (IV, Random, 95% CI)	‐0.20 [‐1.60, 1.20]
2.2 No additive	2	123	Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.87, 0.52]

Comparison 14. Postoperative pain intensity at 48 hours: intravenous dexamethasone versus placebo

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Comparison 15. Postoperative opioid consumption at 24 hours: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 24‐hour opioid consumption Show forest plot	5	287	Mean Difference (IV, Random, 95% CI)	‐6.58 [‐10.56, ‐2.60]

2 24‐hour opioid consumption: additive verus no additive subgroups Show forest plot	5	287	Mean Difference (IV, Random, 95% CI)	‐6.58 [‐10.56, ‐2.60]

2.1 Additive	1	53	Mean Difference (IV, Random, 95% CI)	‐4.0 [‐13.33, 5.33]
2.2 No additive	4	234	Mean Difference (IV, Random, 95% CI)	‐6.93 [‐11.41, ‐2.46]

Comparison 15. Postoperative opioid consumption at 24 hours: intravenous dexamethasone versus placebo

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Comparison 16. Postoperative opioid consumption at 48 hours: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative opioid consumption at 48 hours opioid consumption Show forest plot	1	46	Mean Difference (IV, Random, 95% CI)	‐22.5 [‐39.85, ‐5.15]

Comparison 16. Postoperative opioid consumption at 48 hours: intravenous dexamethasone versus placebo

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Comparison 17. Participant satisfaction with pain control: intravenous dexamethasone versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Participant satisfaction with pain control Show forest plot	3	181	Mean Difference (IV, Random, 95% CI)	1.07 [‐0.08, 2.22]

Comparison 17. Participant satisfaction with pain control: intravenous dexamethasone versus placebo

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Comparison 18. Duration of sensory block: perineural versus intravenous dexamethasone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of sensory block Show forest plot	9	720	Mean Difference (IV, Random, 95% CI)	3.13 [1.68, 4.58]

2 Duration of sensory block additive versus no additive subgroups Show forest plot	9	720	Mean Difference (IV, Random, 95% CI)	3.13 [1.68, 4.58]

2.1 Additive	3	331	Mean Difference (IV, Random, 95% CI)	3.94 [2.66, 5.21]
2.2 No additive	6	389	Mean Difference (IV, Random, 95% CI)	2.67 [0.00, 5.34]
3 Duration sensory block high‐dose versus low‐dose dexamethasone subgroups Show forest plot	9	720	Mean Difference (IV, Random, 95% CI)	3.13 [1.68, 4.58]

3.1 High‐dose dexamethasone	6	508	Mean Difference (IV, Random, 95% CI)	2.35 [0.04, 4.66]
3.2 Low‐dose dexamethasone	3	212	Mean Difference (IV, Random, 95% CI)	4.14 [2.48, 5.81]
4 Duration sensory block high/unclear versus low risk of bias subgroups Show forest plot	9	720	Mean Difference (IV, Random, 95% CI)	3.13 [1.68, 4.58]

4.1 High/unclear risk of bias	3	162	Mean Difference (IV, Random, 95% CI)	4.67 [2.29, 7.04]
4.2 Low risk of bias	6	558	Mean Difference (IV, Random, 95% CI)	2.30 [0.23, 4.37]

Comparison 18. Duration of sensory block: perineural versus intravenous dexamethasone

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Comparison 19. Duration of motor block: perineural versus intravenous dexamethasone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of motor block Show forest plot	5	421	Mean Difference (IV, Random, 95% CI)	3.13 [0.99, 5.27]

2 Duration of motor block: additive versus no additive subgroups Show forest plot	5	340	Mean Difference (IV, Random, 95% CI)	2.75 [0.32, 5.19]

2.1 Additive	1	50	Mean Difference (IV, Random, 95% CI)	4.0 [‐0.03, 8.03]
2.2 No additive	4	290	Mean Difference (IV, Random, 95% CI)	2.39 [‐0.58, 5.37]
3 Duration of motor block: high‐ versus low‐dose dexamethasone subgroups Show forest plot	5	421	Mean Difference (IV, Random, 95% CI)	3.13 [0.99, 5.27]

3.1 High‐dose dexamethasone	4	381	Mean Difference (IV, Random, 95% CI)	2.47 [‐0.25, 5.19]
3.2 Low‐dose dexamethasone	1	40	Mean Difference (IV, Random, 95% CI)	5.0 [2.53, 7.47]
4 Duration of motor block: high/unclear versus low risk of bias subgroups Show forest plot	5	421	Mean Difference (IV, Random, 95% CI)	3.13 [0.99, 5.27]

4.1 HIgh/unclear risk of bias	1	40	Mean Difference (IV, Random, 95% CI)	5.0 [2.53, 7.47]
4.2 Low risk of bias	4	381	Mean Difference (IV, Random, 95% CI)	2.47 [‐0.25, 5.19]

Comparison 19. Duration of motor block: perineural versus intravenous dexamethasone

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Comparison 20. Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Overall incidence of block‐related adverse events Show forest plot	5	406	Risk Ratio (M‐H, Random, 95% CI)	1.20 [0.93, 1.55]

2 Numbness/tingling 14 days after surgery Show forest plot	3	232	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.27, 3.49]

3 Residual motor block/weakness at 24 hours Show forest plot	3	248	Risk Ratio (M‐H, Random, 95% CI)	1.22 [0.62, 2.37]

4 Horner syndrome Show forest plot	2	197	Risk Ratio (M‐H, Random, 95% CI)	1.2 [0.77, 1.87]

5 Hoarsness Show forest plot	2	197	Risk Ratio (M‐H, Random, 95% CI)	1.0 [0.48, 2.09]

6 Cranial nerve 12 motor palsy Show forest plot	1	81	Risk Ratio (M‐H, Random, 95% CI)	0.31 [0.01, 7.39]

7 Overall incidence of non block‐related adverse events Show forest plot	5	316	Risk Ratio (M‐H, Random, 95% CI)	1.34 [0.37, 4.78]

8 Postoperative nausea and vomiting Show forest plot	5	312	Risk Ratio (M‐H, Random, 95% CI)	0.63 [0.22, 1.80]

9 Dermatologicial symptoms (pruritus/rash) Show forest plot	1	79	Risk Ratio (M‐H, Random, 95% CI)	4.42 [0.22, 89.18]

10 Syncope/fainting Show forest plot	1	79	Risk Ratio (M‐H, Fixed, 95% CI)	4.42 [0.22, 89.18]

11 Dizziness Show forest plot	2	178	Risk Ratio (M‐H, Random, 95% CI)	0.41 [0.06, 2.72]

12 Wrist, hand or finger pain Show forest plot	1	79	Risk Ratio (M‐H, Random, 95% CI)	0.29 [0.01, 7.02]

13 Headache, 10‐pound fluid gain/diarrhoea/frequent urination/ muscle soreness Show forest plot	1	79	Risk Ratio (M‐H, Random, 95% CI)	2.65 [0.11, 63.16]

Comparison 20. Incidence of mild to moderate adverse events: perineural versus intravenous dexamethasone

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Comparison 21. Postoperative pain intensity at 12 hours: perineural versus intravenous dexamethasone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 12 hours Show forest plot	3	217	Mean Difference (IV, Random, 95% CI)	‐1.01 [‐1.51, ‐0.50]

2 Postoperative pain intensity at 12 hours: low‐ versus high‐dose dexamethasone subgroups Show forest plot	3	217	Mean Difference (IV, Random, 95% CI)	‐1.01 [‐1.51, ‐0.50]

2.1 Low‐dose dexamethasone	2	139	Mean Difference (IV, Random, 95% CI)	‐1.04 [‐1.60, ‐0.47]
2.2 High‐dose dexamethasone	1	78	Mean Difference (IV, Random, 95% CI)	‐0.90 [‐2.01, 0.21]
3 Postoperative pain intensity at 12 hours: high/unclear versus low risk of bias subgroups Show forest plot	3	217	Mean Difference (IV, Random, 95% CI)	‐1.01 [‐1.51, ‐0.50]

3.1 HIgh/unclear risk of bias	2	139	Mean Difference (IV, Random, 95% CI)	‐1.04 [‐1.60, ‐0.47]
3.2 Low risk of bias	1	78	Mean Difference (IV, Random, 95% CI)	‐0.90 [‐2.01, 0.21]

Comparison 21. Postoperative pain intensity at 12 hours: perineural versus intravenous dexamethasone

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Comparison 22. Postoperative pain intensity at 24 hours: perineural versus intravenous dexamethasone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 24 hours Show forest plot	5	309	Mean Difference (IV, Random, 95% CI)	‐0.79 [‐1.51, ‐0.07]

2 Postoperative pain intensity at 24 hours: additive versus no additive subgroups Show forest plot	5	309	Mean Difference (IV, Random, 95% CI)	‐0.79 [‐1.51, ‐0.07]

2.1 Additive	1	50	Mean Difference (IV, Random, 95% CI)	‐1.70 [‐3.32, ‐0.08]
2.2 No additive	4	259	Mean Difference (IV, Random, 95% CI)	‐0.64 [‐1.41, 0.13]
3 Postoperative pain intensity at 24 hours: low‐ versus high‐dose dexamethasonesubgroups Show forest plot	5	309	Mean Difference (IV, Random, 95% CI)	‐0.79 [‐1.51, ‐0.07]

3.1 Low‐dose dexamethasone	2	139	Mean Difference (IV, Random, 95% CI)	‐0.95 [‐2.01, 0.11]
3.2 High‐dose dexamethasone	3	170	Mean Difference (IV, Random, 95% CI)	‐0.68 [‐1.95, 0.59]
4 Intensity of postoperative pain at 24 hours: high/unclear risk of bias versus low risk of bias subgroups Show forest plot	5	309	Mean Difference (IV, Random, 95% CI)	‐0.79 [‐1.51, ‐0.07]

4.1 High/unclear risk of bias	2	139	Mean Difference (IV, Random, 95% CI)	‐0.95 [‐2.01, 0.11]
4.2 Low risk of bias	3	170	Mean Difference (IV, Random, 95% CI)	‐0.68 [‐1.95, 0.59]

Comparison 22. Postoperative pain intensity at 24 hours: perineural versus intravenous dexamethasone

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Comparison 23. Postoperative pain intensity at 48 hours: perineural versus intravenous dexamethasone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Postoperative pain intensity at 48 hours Show forest plot	3	227	Mean Difference (IV, Random, 95% CI)	0.13 [‐0.35, 0.61]

2 Postoperative pain intensity at 48 hours: additive versus no additive subgroups Show forest plot	3	227	Mean Difference (IV, Random, 95% CI)	0.13 [‐0.35, 0.61]

2.1 Additive	1	50	Mean Difference (IV, Random, 95% CI)	0.80 [‐0.51, 2.11]
2.2 No additive	2	177	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.50, 0.54]
3 Postoperative pain intensity at 48 hours: low‐ versus high‐dose dexamethasone subgroups Show forest plot	3	227	Mean Difference (IV, Random, 95% CI)	0.13 [‐0.35, 0.61]

3.1 Low‐dose dexamethasone	1	99	Mean Difference (IV, Random, 95% CI)	0.0 [‐0.59, 0.59]
3.2 High‐dose dexamethasone	2	128	Mean Difference (IV, Random, 95% CI)	0.39 [‐0.45, 1.24]
4 Postoperative pain intensity at 48 hours: high/unclear versus low risk of bias subgroups Show forest plot	3	227	Mean Difference (IV, Random, 95% CI)	0.13 [‐0.35, 0.61]

4.1 High/unclear risk of bias	1	99	Mean Difference (IV, Random, 95% CI)	0.0 [‐0.59, 0.59]
4.2 Low risk of bias	2	128	Mean Difference (IV, Random, 95% CI)	0.39 [‐0.45, 1.24]

Comparison 23. Postoperative pain intensity at 48 hours: perineural versus intravenous dexamethasone

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Comparison 24. Postoperative opioid consumption at 24 hours: perineural versus intravenous dexamethasone opioid consumption: perineural versus intravenous dexamethasone subgroups

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Opioid consumption at 24 hours: perineural versus intravenous dexamethasone Show forest plot	4	242	Mean Difference (IV, Random, 95% CI)	‐3.87 [‐9.93, 2.19]

2 24‐hour opioid consumption: additive versus no additive subgroups Show forest plot	4	242	Mean Difference (IV, Random, 95% CI)	‐3.87 [‐9.93, 2.19]

2.1 Additive	1	53	Mean Difference (IV, Random, 95% CI)	‐10.00 [‐23.96, ‐0.04]
2.2 No additive	3	189	Mean Difference (IV, Random, 95% CI)	‐1.56 [‐6.34, 3.22]

Comparison 24. Postoperative opioid consumption at 24 hours: perineural versus intravenous dexamethasone opioid consumption: perineural versus intravenous dexamethasone subgroups

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Comparison 25. Participant satisfaction with pain control: perineural versus intravenous dexamethasone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Participant satisfaction with pain control Show forest plot	3	181	Mean Difference (IV, Random, 95% CI)	0.19 [‐0.33, 0.70]

Comparison 25. Participant satisfaction with pain control: perineural versus intravenous dexamethasone

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