Document resource
Background Concerns about opioid-related adverse effects and local anesthetic toxicity often limit effective postoperative pain management in pediatric patients. This study aimed to compare the analgesic efficacy and systemic effects of perineural dexamethasone (DEX) versus dexmedetomidine (DEM) when used as adjuvants to ropivacaine in pediatric popliteal sciatic nerve blocks.Methods In this triple-blinded, randomized controlled trial, 90 children aged 3 months to 7 years (American Society of Anesthesiologists (ASA) I–III) undergoing elective foot or ankle surgery at a single academic center were randomized to receive ultrasound-guided popliteal sciatic nerve blocks with 0.2% ropivacaine combined with either DEX (0.1 mg/kg), DEM (0.1 µg/kg), or saline (placebo). The primary outcome was time to first rescue opioid administration. Secondary outcomes included total opioid consumption (µg/kg nalbuphine), Face-Legs-Activity-Cry-Consolability (FLACC) pain scores at predefined intervals (4–48 hours) and systemic inflammatory markers (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio). Statistical analysis included Kruskal–Wallis and Fisher’s exact tests with Bonferroni correction.Results Mean time to first opioid use was 19.4 ± 2.0 hours for DEX, 18.4 ± 1.7 hours for DEM, and 8.5 ± 1.2 hours for placebo (p < 0.0001); the difference between DEX and DEM was 1.0 hour (95% CI 0.04 to 2.06; p=0.0400). Nalbuphine was required in 23.3% of DEX, 33.3% of DEM, and 90% of placebo patients. Total opioid consumption was lower in adjuvant groups (DEX, 40.0 ± 77.0 µg/kg; DEM, 46.7 ± 73.0 µg/kg) compared with placebo (123.3 ± 62.6 µg/kg). FLACC scores were significantly reduced at 6, 8, and 12 hours in both adjuvant groups. NLR at 48 hours was significantly lower in the dexamethasone group (p=0.0136). No nerve injuries or hemodynamic complications occurred.Conclusions Both adjuvants prolonged analgesia and reduced opioid requirements. Although DEX produced slightly longer analgesia than DEM, the clinical significance of this difference may be limited. Larger studies are needed to confirm safety.Trial registration number ClinicalTrials.gov Identifier: NCT06233565.