Co-administration of dexamethasone with peripheral nerve block: intravenous vs perineural application: systematic review, meta-analysis, meta-regression.

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Presentation transcript:

Co-administration of dexamethasone with peripheral nerve block: intravenous vs perineural application: systematic review, meta-analysis, meta-regression and trial- sequential analysis M. Heesen, M. Klimek, G. Imberger, S.E. Hoeks, R. Rossaint, S. Straube British Journal of Anaesthesia Volume 120, Issue 2, Pages 212-227 (February 2018) DOI: 10.1016/j.bja.2017.11.062 Copyright © 2017 Terms and Conditions

Fig 1 Selection of articles for our systematic review. Dexa, dexamethasone; IV, intravenously; n, number of studies. British Journal of Anaesthesia 2018 120, 212-227DOI: (10.1016/j.bja.2017.11.062) Copyright © 2017 Terms and Conditions

Fig 2 Risk of bias assessment. British Journal of Anaesthesia 2018 120, 212-227DOI: (10.1016/j.bja.2017.11.062) Copyright © 2017 Terms and Conditions

Fig 3 Meta-analysis: duration of analgesia (min). British Journal of Anaesthesia 2018 120, 212-227DOI: (10.1016/j.bja.2017.11.062) Copyright © 2017 Terms and Conditions

Fig 4 Meta-regression of the dose of dexamethasone (mg) on the duration of analgesia (min). Random effect meta-regression plot of the impact of dexamethasone dosage on the pooled mean difference in duration of analgesia. The size of each circle is inversely proportional to the variance of the estimated treatment effect. British Journal of Anaesthesia 2018 120, 212-227DOI: (10.1016/j.bja.2017.11.062) Copyright © 2017 Terms and Conditions

Fig 5 Trial-sequential analysis of nine trials comparing perineural dexamethasone with i.v. dexamethasone for the duration of analgesia. The blue line represents the summary of what has been found after each trial, the Z score resulting from the cumulative evidence. The curved red lines are the TSA monitoring boundaries, for benefit (on the top of the graph), harm (on the bottom of the graph) and futility (the inner wedge). The horizontal red lines represent a conventional, constant threshold for significance at a z value of 1.96. The RIS is the required information size, which is an estimate of the number of participants required to answer the defined question. The calculation of the RIS depends on the assumptions defined in the methods section (as with a sample size calculation for a single trial) and also incorporates an estimate for heterogeneity. This graph shows that the evidence for this meta-analysis crosses the trial sequential analysis monitoring boundary before it reached the required information size and then went on to pass the required information size itself. We can therefore conclude with reasonable certainty that perineural dexamethasone does provide a longer duration of analgesia than i.v. dexamethasone. British Journal of Anaesthesia 2018 120, 212-227DOI: (10.1016/j.bja.2017.11.062) Copyright © 2017 Terms and Conditions