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almost 2 years ago

"Dexamethasone Dilemma: Why IV vs. Perineural Comparisons Fall Short" #Dexamethasone #PerineuralDexaVsIV #RegionalAnesthesia #PainManagement #AnesthesiaScience #Pharmacokinetics #ClinicalOutcomes #AnesthesiaDebate #MedicalResearch #PostoperativeCare Just My Opinion, The comparison between IV Dexamethasone and Perineural Dexamethasone can appear invalid or unscientific for several reasons: 1. Mechanism of Action: Perineural dexamethasone is applied directly near the nerves, which allows for a localized anti-inflammatory and analgesic effect. In contrast, IV dexamethasone is distributed systemically, with a less concentrated impact on the targeted nerve area. The mechanism of action differs significantly, making a direct comparison less meaningful. 2. Pharmacokinetics: When dexamethasone is administered intravenously, it first circulates through the heart and lungs before reaching the systemic circulation and, eventually, the nerves. This dilution and distribution reduce its local concentration at the site of nerve blocks. On the other hand, perineural dexamethasone is administered directly where it's needed, leading to a higher local concentration and potentially more effective nerve block prolongation. 3. Clinical Outcomes: Studies comparing the effectiveness of IV versus perineural dexamethasone often show different outcomes in terms of analgesia duration and quality. The local administration generally provides a more consistent and predictable extension of nerve block duration compared to systemic administration. 4. Different Objectives: IV dexamethasone is often used for its systemic anti-inflammatory effects and overall postoperative pain relief, while perineural dexamethasone is used to prolong the effects of regional anesthesia specifically. Comparing them is like comparing two different treatments with different primary objectives. Perineural Dexa: 1. Dexamethasone reduces stimulus transmission in unmyelinated C-fibers, known to carry nociceptive information by inhibiting the activity of the potassium channels on these fibers. This will decrease the amount of pain sensed by a patient. 2. Secondly, it is thought that dexamethasone causes a degree of vasoconstriction to the tissues and local anesthetic will have a slower uptake and absorption thus, prolonging its duration and amount of comfort felt by the patient. 3. Thirdly, dexamethasone exhibits a potent anti-inflammatory effect and inhibits the release of inflammatory mediators like interleukins and cytokines; it promotes the release of anti-inflammatory mediators, leading to decreased postoperative pain. 4. Dexamethasone has been found to increase levels of the enzyme serine-threonine protein kinase B (aka Akt) and lead to attenuated neurotoxicity of bupivacaine and lidocaine. Akt protects against apoptosis under various conditions, such as glutamate toxicity or oxygen or glucose deprivation. All these Local effects u won't get with IV dexa. In Summary, The comparison between IV and perineural dexamethasone is often considered unscientific because they act through different mechanisms, have different pharmacokinetics and serve different clinical purposes. This is akin to comparing two distinct methods of treatment that happen to use the same drug but in fundamentally different ways.

KartikBSonawane's tweet photo. "Dexamethasone Dilemma: Why IV vs. Perineural Comparisons Fall Short"

#Dexamethasone #PerineuralDexaVsIV
#RegionalAnesthesia #PainManagement #AnesthesiaScience #Pharmacokinetics #ClinicalOutcomes #AnesthesiaDebate #MedicalResearch #PostoperativeCare

Just My Opinion,

The comparison between IV Dexamethasone and Perineural Dexamethasone can appear invalid or unscientific for several reasons:

1. Mechanism of Action:

Perineural dexamethasone is applied directly near the nerves, which allows for a localized anti-inflammatory and analgesic effect.

In contrast, IV dexamethasone is distributed systemically, with a less concentrated impact on the targeted nerve area.

The mechanism of action differs significantly, making a direct comparison less meaningful.

2. Pharmacokinetics:

When dexamethasone is administered intravenously, it first circulates through the heart and lungs before reaching the systemic circulation and, eventually, the nerves. This dilution and distribution reduce its local concentration at the site of nerve blocks.

On the other hand, perineural dexamethasone is administered directly where it's needed, leading to a higher local concentration and potentially more effective nerve block prolongation.

3. Clinical Outcomes:

Studies comparing the effectiveness of IV versus perineural dexamethasone often show different outcomes in terms of analgesia duration and quality.

The local administration generally provides a more consistent and predictable extension of nerve block duration compared to systemic administration.

4. Different Objectives:

IV dexamethasone is often used for its systemic anti-inflammatory effects and overall postoperative pain relief, while perineural dexamethasone is used to prolong the effects of regional anesthesia specifically.

Comparing them is like comparing two different treatments with different primary objectives.

Perineural Dexa:

1. Dexamethasone reduces stimulus transmission in unmyelinated C-fibers, known to carry nociceptive information by inhibiting the activity of the potassium channels on these fibers. This will decrease the amount of pain sensed by a patient.

2. Secondly, it is thought that dexamethasone causes a degree of vasoconstriction to the tissues and local anesthetic will have a slower uptake and absorption thus, prolonging its duration and amount of comfort felt by the patient.

3. Thirdly, dexamethasone exhibits a potent anti-inflammatory effect and inhibits the release of inflammatory mediators like interleukins and cytokines; it promotes the release of anti-inflammatory mediators, leading to decreased postoperative pain.

4. Dexamethasone has been found to increase levels of the enzyme serine-threonine protein kinase B (aka Akt) and lead to attenuated neurotoxicity of bupivacaine and lidocaine. Akt protects against apoptosis under various conditions, such as glutamate toxicity or oxygen or glucose deprivation.

All these Local effects u won't get with IV dexa.

In Summary,

The comparison between IV and perineural dexamethasone is often considered unscientific because they act through different mechanisms,
have different pharmacokinetics and
serve different clinical purposes.

This is akin to comparing two distinct methods of treatment that happen to use the same drug but in fundamentally different ways.

South University @SouthU

about 5 years ago

Have you known since childhood what you were interested in and what you wanted to do when you 'grew up'? Heather Pass, Assistant Professor of #SouthUniversity's Master of Medical Science in #AnesthesiaScience program knew in her first science class! #AnesthesiologistAssistant

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