Effect of intravenous dexamethasone on duration of analgesia following popliteal nerve block in pediatric ankle surgery: A randomized, triple-blinded clinical trial.

BACKGROUND

Effective postoperative pain control in pediatric foot and ankle surgery remains challenging. Popliteal nerve blocks are widely used but limited by their short duration. Systemic dexamethasone may prolong analgesia, yet evidence in pediatric regional anesthesia remains sparse.

OBJECTIVE

To assess the analgesic efficacy and safety of two intravenous dexamethasone doses (0.1 mg/kg and 0.2 mg/kg) administered before a single-shot popliteal nerve block in children undergoing ankle or foot surgery.

METHODS

In this randomized, triple-blinded clinical trial, 90 pediatric patients were allocated to receive either placebo, 0.1 mg/kg, or 0.2 mg/kg dexamethasone intravenously prior to popliteal nerve block. The primary outcome was time to first opioid requirement. Secondary outcomes included total opioid consumption, FLACC pain scores, inflammatory markers (NLR, PLR), blood glucose, and time to motor recovery.

RESULTS

Both dexamethasone groups had significantly longer opioid-free intervals compared to placebo (12.3 ± 2.4 h and 13.7 ± 2.6 h vs. 7.5 ± 2.2 h; p < 0.0001). Opioid consumption was lowest in the 0.2 mg/kg group (p = 0.0292). Pain scores and inflammatory markers were consistently lower in dexamethasone groups. However, blood glucose levels increased dose-dependently, with the highest values in the 0.2 mg/kg group. Motor recovery was also delayed with dexamethasone use.

CONCLUSION

Intravenous dexamethasone effectively prolongs analgesia and reduces opioid requirements after pediatric foot and ankle surgery. While 0.2 mg/kg provides maximal benefit, 0.1 mg/kg may offer an optimal balance between efficacy and metabolic safety.

TRIAL REGISTRATION: ClinicalTrials.gov (NCT05887765).