Written by Jonathan Brewer
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Dexamethasone is associated with improved pain control within 60 minutes as an adjunct to ultrasound-guided nerve blocks (UGNBs) when compared to epinephrine, without an increased risk of complications.
Add the dex… forget the rest
This retrospective analysis of 1,799 ED-performed UGNBs from the NURVE registry assessed adjunct dexamethasone or epinephrine mixed with anesthetic vs. anesthetic alone. Using a mixed-effects model to control for clinician and patient factors, dexamethasone was found to significantly have > 50% pain reduction within 60 minutes (OR 1.99) compared to epinephrine (OR 0.99), without any increase in adverse events. Both have been shown to increase the duration of nerve blocks. While most of these studies were limited to large academic centers with variable standard adjunct use across sites, the complication rate was minimal. I personally am very excited about this paper because this is the first examination of the addition of adjuncts to UGNBs specifically in the emergency department.
How will this change my practice?
I continue to be an advocate for regional anesthesia in the emergency department. UGNBs have long been shown to change patient management, decrease opiate use, and improve pain scores and patient satisfaction. Based on this study, I will continue to utilize dexamethasone as an adjunct, but as there is still no dose-response association identified, I will use a 4 mg dose until further research clarifies this.
Source
Efficacy and Safety of Adjunct Medications in ED Ultrasound-Guided Nerve Blocks: A National Ultrasound-Guided NeRVE (NURVE) Block Registry Study. Acad Emerg Med. 2025 Aug 27. doi: 10.1111/acem.70128. Epub ahead of print. PMID: 40873157.
Given as an i.v. or as an additive?
These were added to the local anesthetic, not IV in this study.