[Glucocorticoids as an adjunct in peripheral regional anesthesia. Move to the "Holy Grail of perineural analgesia"?!].

BACKGROUND: The role of dexamethasone as an adjunct in peripheral nerve blockades is still unclear.

OBJECTIVES: This article reviews the actual knowledge and scientific evidence for dexamethasone as an adjunct in peripheral regional anesthesia. Moreover, it discusses the benefits of the systemic versus the perineural mode of application.

RESULTS: Dexamethasone prolongs sensible as well as motor blockades in peripheral nerve blocks when applied intravenously or perineurally. Regarding potentially local neurotoxicity, published patient data are not sufficient for final conclusions.

CONCLUSIONS: After reviewing the actual literature, the authors prefer a systemic application mode (intravenously) over a perineural route of administration of dexamethasone as an adjunct for peripheral nerve blocks. This is due to the better understanding of potential side effects of the drug when applied intravenously. Dexamethasone might be a useful drug adjunct to prolong peripheral single shot nerve blocks.