Timing of intravenous dexamethasone and analgesia after brachial plexus block: a randomized, double-blind, placebo-controlled trial
Bibliographic record
Abstract
BACKGROUND: The addition of intravenous dexamethasone can significantly prolong analgesia and reduce opioid-related side effects after brachial plexus blockade, but the most effective administration time is yet unknown. The objective of this study is to determine if the timing of administration of dexamethasone affects the duration of analgesia after supraclavicular brachial plexus block. METHODS: This is a double-blind, placebo-controlled, randomized trial performed at a single-center, tertiary academic health sciences center. Patients were randomly assigned to one of four treatment groups to receive dexamethasone 8 mg intravenously (or normal saline infusions) at 1-hour preblock, at the time of the block, and 1 or 2 hours postblock. RESULTS: 197 patients were randomized and received the intervention (in one of four treatment groups) between January 2018 and November 2023. 39 patients were excluded due to loss to follow-up and unavailability of primary outcome data. The remaining 158 patients have complete data sets and were analyzed. The time to first reported pain was not significantly different between groups (p=0.904). Secondary outcomes including pain scores and opioid consumption, recovery scores and block recovery time did not vary significantly among groups up to 48 hours. Adverse effects such as postoperative neurological symptoms and nausea were similar across groups up to 3 months postoperatively. CONCLUSIONS AND RELEVANCE: Our results suggest that perioperative administration of 8 mg of intravenous dexamethasone (from 1 hour prior and up to 2 hours postblock) provides similar duration of analgesia to administration at the time of brachial plexus block. TRIAL REGISTRATION NUMBER: NCT03394820.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".