Systemic Steroids for Peripheral Nerve Blocks
Systemic Steroids for Peripheral Nerve Blocks
This study will investigate the ability of systemic dexamethasone to prolong the sensory
 block duration for lumbar plexus nerve blockade.
The purpose of this randomized, double-blinded, placebo-controlled trial is to examine the
 equivalency of two different doses of dexamethasone when given intravenously as an adjuvant
 medication for postoperative pain management. Specifically, this study will investigate the
 prolongation of time to recovery of sensation following a lumbar plexus block in patients
 undergoing total hip arthroplasties. The investigators hypothesize that dexamethasone will
 prolong the sensory block time when compared to placebo and that similar results will be
 obtained in the 4 mg arm when compared to the 8 mg arm. The primary end point will be time to
 sensory recovery in the femoral nerve cutaneous distribution (part of the lumbar plexus) as
 determined by pin-prick sensation assessment. Secondary endpoints will include, but are not
 be limited to: time to first opioid administration, total opioid consumption over 30 hours,
 and rest and incident verbal numerical pain scores at 6,12,18,24 and 30 hours post block
 placement.
Inclusion Criteria: Primary elective total hip arthroplasty surgery

 -  must be a candidate for placement of a lumbar plexus block under anatomic landmark
 technique using electrical stimulation

 -  must give written informed consent for anesthesia

 -  must also be reliable and able to give accurate verbal pain scores postoperatively

 Exclusion Criteria:

 -  contraindications to regional anesthesia including, allergy to amide local
 anesthetics, presence of peripheral neurologic dysfunction, pre-existing coagulopathy
 or infection in the area of interest will be excluded.

 -  insulin and non-insulin dependent diabetes mellitus

 -  preoperative use of systemic corticosteroids within 30 days of surgery

 -  chronic opioid use (defined as daily opioid dose of greater than 40 mg of oxycodone
 equivalents or any long-acting opioid)

 -  pregnancy

 -  failure to effectively place the lumbar plexus block.

 -  known prior adverse reaction to dexamethasone (for example: psychosis) or an allergy
 to dexamethasone