Perineural dexamethasone extends single-injection block duration by several hours, without a catheter to secure, programme or remove. For motor-sparing knee blocks, it is often enough to carry patients past the worst of rebound pain when combined with periarticular infiltration and regular oral analgesia.
- Use preservative-free dexamethasone; perineural use is off-label, so document it.
- Pair with scheduled paracetamol and an NSAID where not contraindicated.
- Warn patients about rebound pain as the block wears off and to take oral analgesia before it does.
- Check glucose in patients with diabetes.
Why it matters
It extends block duration without the equipment, cost or buckling risk of a catheter.
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