Perineural dexamethasone: neurotoxicity or neuroprotection? A systematic review of preclinical evidence
Rattachement africain : it, tr. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Perineural dexamethasone is widely used as an adjuvant to local anesthetics in regional anesthesia to prolong analgesia. However, concerns persist regarding its potential neurotoxic effects, particularly when administered perineurally. This systematic review aims to synthesize preclinical evidence evaluating the neurotoxicity or neuroprotective properties of perineural dexamethasone. METHODS: A systematic search of PubMed, CENTRAL, Scopus, and Embase was conducted through May 22, 2025. Eligible studies included in vivo or in vitro preclinical models assessing the neurotoxic or neuroprotective effects of perineural dexamethasone compared to control conditions. Risk of bias was assessed using the SYRCLE tool for in vivo studies and a narrative evaluation for in vitro studies. A total of 14 studies (11 in vivo, 3 in vitro) met inclusion criteria. RESULTS: In vitro studies showed that dexamethasone alone was not neurotoxic at clinically relevant doses but could enhance cytotoxicity when combined with local anesthetics at higher concentrations. In vivo models generally demonstrated no significant long-term nerve inflammation, degeneration or demyelination, with some early protective effects observed in perineural dexamethasone groups. However, all in vivo studies were rated at high risk of bias. In nerve injury models, dexamethasone reduced apoptotic and inflammatory markers when administered immediately post-injury, with limited effect when delayed. CONCLUSIONS: Preclinical evidence supports the general safety of low-dose, preservative-free perineural dexamethasone. Nonetheless, high-dose use, additives, and application in patients with neuropathies may pose risks. Given the high risk of bias in existing studies and minimal added benefit over systemic administration, clinical caution is advised.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Perineural dexamethasone: neurotoxicity or neuroprotection? A systematic review of preclinical evidence
- Date Crossref
- 06/08/2025
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Padua Department of Medicine (DIMED) pays non établi dans la noticeUniversité ou école supérieure
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Ospedale “M. Bufalini” di Cesena pays non établi dans la noticeÉtablissement de santé
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University of Campania "Luigi Vanvitelli" Department of Woman pays non établi dans la noticeUniversité ou école supérieure
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Ospedale di Prato Santo Stefano pays non établi dans la noticeÉtablissement de santé
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University of Modena and Reggio Emilia pays non établi dans la noticeUniversité ou école supérieure
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Ondokuz Mayıs University Department of Anaesthesiology and Reanimation pays non établi dans la noticeUniversité ou école supérieure
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University Hospital of Padua Institute of Anesthesia and Intensive Care Unit pays non établi dans la noticeUniversité ou école supérieure
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M.Bufalini Hospital Anesthesia and Intensive Care Unit pays non établi dans la noticeÉtablissement de santé
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“Nuovo Ospedale della Costiera” Hospital Anesthesia and Intensive Care Unit pays non établi dans la noticeÉtablissement de santé
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"Nuovo Ospedale della Costiera" Hospital Anesthesia and Intensive Care Unit pays non établi dans la noticeÉtablissement de santé
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University Hospital of Modena Department of Anesthesia and Intensive Care pays non établi dans la noticeUniversité ou école supérieure
Department of Medicine (DIMED) — University of Padua, Ospedale “M. Bufalini” di Cesena et Department of Woman — University of Campania "Luigi Vanvitelli", avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.