Is there a benefit to adding dexamethasone to levobupivacaine in ultrasound-guided adductor canal block following anterior cruciate ligament reconstruction?

TL;DR

This study found no benefit in adding dexamethasone to a nerve block after ACL surgery, as it did not reduce pain or opioid use and increased blood glucose levels.

Contribution

The study provides evidence against the routine use of dexamethasone in adductor canal blocks for ACL reconstruction.

Findings

No significant difference in pain levels between groups within 24 hours post-surgery.

No significant difference in opioid use between groups during the first 48 hours.

Dexamethasone group had significantly higher blood glucose levels.

Abstract

Reconstruction of the anterior cruciate ligament (ACL) often causes severe postoperative pain. This study aimed to assess how dexamethasone affects the analgesic effectiveness of the adductor canal block (ACB), opioid use, and rebound pain after ACL reconstruction with a bone-patellar tendon-bone (BPTB) graft.

This non-randomized prospective study analyzed a total of 160 patients, who were divided into two groups: the Dexamethasone + ACB group and the ACB group.

Within the first 24 h after surgery, there was no difference between the groups in the percentage of patients experiencing pain (73.75% vs. 85%; χ2 = 2.4433; p = 0.118) or in pain severity during activity (1.74 ± 0.97 vs. 1.59 ± 0.65; p = 0.779). During the first 48 h after surgery, no significant difference was observed in opioid use between the groups. Three patients in the non-dexamethasone group reported rebound pain (χ2 = 0.2564; p = 0.61), while blood glucose levels were significantly higher in the dexamethasone group (χ2 = 4.329; p = 0.037).

The addition of dexamethasone to the local anesthetic during ACB after ACL reconstruction is not supported due to the lack of benefits related to postoperative pain levels and the associated increase in glucose levels.

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