Comparison of Perineural Versus Intravenous Dexamethasone as an Adjuvant to Brachial Plexus Block in Pediatric Hand and Forearm Surgery A Randomized Double-Blind Placebo-Controlled Trial With Neurological Safety Evaluation and Neurofilament Light Chain Biomarker Assessment

What this Trial Is About

Researchers are evaluating the neurological safety and pain-relieving effects of dexamethasone given either around the nerve (perineurally) or through a vein (intravenously) as an add-on to a brachial plexus nerve block in children having hand or forearm surgery. This clinical trial aims to understand whether perineural dexamethasone causes nerve injury compared to intravenous dexamethasone or placebo. The study will also explore long-term safety, which has limited evidence especially for children. All participants will receive a single brachial plexus block with ropivacaine guided by ultrasound. They will be randomly assigned to one of three groups: perineural dexamethasone, intravenous dexamethasone, or placebo (normal saline) given both ways. The doses are weight-based with maximum limits. The trial is double-blind, meaning neither participants nor researchers know the group assignments. Treatment effects will be compared over a 12-month period. During the study, neurological function will be assessed through clinical exams and blood tests measuring serum neurofilament light chain, a marker for nerve damage. Researchers will also evaluate pain levels using standard scales, opioid use after surgery, and any adverse events. Follow-up will continue for 12 months to monitor nerve safety and recovery outcomes. This may help establish safe dosing and administration guidelines for dexamethasone in pediatric nerve blocks.

Perineural vs Intravenous Dexamethasone as an Adjuvant to Brachial Plexus Block in Pediatric Hand Surgery