Dexamethasone vs Dexmedetomidine in Pediatric Peripheral Nerve Blocks for Postoperative Analgesia: A Systematic Review and Network Meta-analysis.

PURPOSE: Peripheral nerve blocks (PNBs) offer adequate postoperative analgesia in pediatric surgical patients while minimizing systemic opioid use. To enhance block duration and quality, adjuvants such as dexmedetomidine and dexamethasone are frequently added to local anesthetics. However, the comparative efficacy and safety profiles of these treatments in children remain unclear.

METHODS

We performed a systematic review and network meta-analysis of 17 randomized controlled trials comprising 1247 pediatric patients undergoing surgery with PNBs. Interventions included perineural and intravenous dexmedetomidine or dexamethasone versus control. The primary outcome was duration of analgesia (time to first rescue analgesic); secondary outcomes included total opioid consumption, postoperative pain scores at 4, 8, 12, and 24 h, and incidence of adverse events.

FINDINGS: Perineural dexmedetomidine produced the most extended analgesia duration (mean difference: +6.77 h vs. control), ranking highest in network analysis. However, it did not significantly reduce opioid use. In contrast, dexamethasone-especially via perineural route-significantly reduced postoperative opioid consumption and was associated with lower pain scores at 8 and 12 h postoperatively. Dexamethasone also decreased the incidence of postoperative nausea and vomiting, whereas dexmedetomidine showed no such benefit

CONCLUSIONS

Dexmedetomidine offers superior prolongation of block duration but lacks significant opioid-sparing effects. Dexamethasone, despite a shorter block duration, is more effective in reducing opioid consumption and postoperative pain intensity. These differences may be explained by rebound pain or anti-inflammatory mechanisms. Clinical priorities should guide the choice of adjuvant. Further high-quality trials are needed to validate these findings and explore long-term safety.