A Prospective Randomized Controlled Trial Comparing Single-Shot Liposomal Bupivacaine vs Liposomal Bupivacaine Combined with Dexamethasone for Foot and Ankle Procedures

Research Type: Level 1 - Randomized controlled trial (RCT), Meta-analysis of randomized trials with homogeneous results Introduction/Purpose: A 2020 study evaluated the addition of dexamethasone to popliteal nerve blocks but failed to demonstrate a significant difference due to being underpowered, highlighting the need for further investigation. This study evaluates the effectiveness of liposomal bupivacaine alone versus in combination with dexamethasone in popliteal and saphenous nerve blocks for foot and ankle surgeries. The primary aim is to assess whether adding dexamethasone reduces postoperative narcotic use and prolongs pain relief. Additionally, the study introduces a novel ultrasound technique, the "hummingbird" sign, for improved saphenous block localization. Methods: This prospective, randomized controlled trial included patients undergoing foot and ankle surgeries, all performed by the same surgeon and anesthesiologist. Participants were randomly assigned to two groups: Group 1 received 20 mL liposomal bupivacaine and 10 mL 0.75% bupivacaine, while Group 2 received 20 mL liposomal bupivacaine, 10 mg preservative-free dexamethasone, and 10 mL 0.75% bupivacaine. Patients were surveyed for pain, opioid use, and other analgesic medications (including Toradol, acetaminophen, and ketorolac) at 7 days post-surgery, with a final survey at 14 days. The study aimed to compare the effects of these two formulations on pain relief and opioid consumption. Results: Preliminary analysis of the data suggests trends in favor of dexamethasone (Group 1) for pain management. Group 1 used significantly fewer ketorolac pills (0.50 vs. 1.21, p = 0.001) and reported a longer duration of effective nerve block (6.50 days vs. 4.88 days, p = 0.002). While no significant differences were found in pain levels, satisfaction, or opioid use (p > 0.05), the results so far indicate potential benefits of dexamethasone in improving pain control and reducing opioid use. Further analysis with a complete sample will provide more definitive conclusions. Conclusion: Preliminary findings suggest that both liposomal bupivacaine formulations reduce opioid use and provide pain relief, with dexamethasone potentially extending the duration of analgesia. While trends favor dexamethasone in reducing ketorolac use and prolonging nerve block efficacy, further research with a complete sample is needed to confirm these results and assess their clinical significance.