Spine Journal - 2026-07-01 - Journal Article; Randomized Controlled Trial
Dexamethasone as an adjuvant to erector spinae plane block is associated with improved neuromonitoring parameters and analgesia in pediatric spine surgery.
Reysner M, Huber J, Reysner T, Janusz P, Glowka P, Gola W, Perek A, Marszałek-Buko J, Daroszewski P, Kotwicki T
Topics
Key Takeaway
Adding dexamethasone 0.1 mg/kg to erector spinae plane block in pediatric posterior spinal fusion extended time to first rescue opioid from 5.2 to 13.0 hours and reduced 48-hour morphine consumption by 34% (27.3 vs 18.1 mg MEq).
Summary Depth
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Summary
This double-blind RCT randomized 60 adolescents (ages 10–18) with Lenke type 3 AIS undergoing posterior spinal fusion to bilateral ESPB with ropivacaine 0.2% plus dexamethasone 0.1 mg/kg versus ropivacaine alone. The DEX group had significantly longer time to first opioid (13.0 vs 5.2 hours, p<0.0001), lower 48-hour morphine consumption (18.1 vs 27.3 mg MEq, p<0.0001), and lower NRS scores at 8, 12, and 24 hours. Postoperative MEP amplitudes and peroneal ENG parameters were more favorable in the DEX group, though both groups showed overall neurophysiological improvement attributed to scoliosis correction.
Key Limitation
The 48-hour observation window does not capture analgesic adequacy or opioid consumption beyond the immediate perioperative period, leaving the duration of any meaningful clinical benefit undefined.
Original Abstract
BACKGROUND CONTEXT
Posterior spinal fusion for idiopathic scoliosis in children and adolescents is associated with severe postoperative pain and high opioid requirements. The erector spinae plane block (ESPB) provides effective analgesia, but its duration is limited. Dexamethasone prolongs peripheral nerve blocks in adults; however, its effects on analgesia and neurophysiological parameters in pediatric spine surgery remain unclear.
PURPOSE
To evaluate whether dexamethasone administered within the fascial plane as an adjuvant to ESPB is associated with prolonged analgesia, reduced opioid consumption, and changes in motor neurophysiological parameters in pediatric scoliosis surgery.
STUDY DESIGN/SETTING
Prospective, randomized, double-blind, controlled clinical trial conducted at a tertiary university hospital.
PATIENT SAMPLE
Sixty children and adolescents aged 10 to 18 years with Lenke type 3 scoliosis undergoing posterior spinal fusion were randomized to receive ESPB with ropivacaine 0.2% plus dexamethasone (0.1 mg/kg; DEX group, n=30) or ropivacaine 0.2% alone (NO DEX group, n=30).
OUTCOME MEASURES
Primary outcome was time to first rescue opioid analgesia within 48 hours postoperatively. Secondary outcomes included total opioid consumption, postoperative pain scores (Numerical Rating Scale, NRS), perioperative blood glucose levels, neurological complications, intraoperative motor evoked potentials (MEPs), and postoperative electroneurography (ENG) parameters.
METHODS
Bilateral ultrasound-guided ESPBs were performed at T4 and T10 after anesthesia induction. Neuromonitoring included intraoperative transcranial electrical stimulation-elicited MEPs and postoperative transcranial magnetic stimulation-elicited MEPs, as well as postoperative motor ENG of the peroneal nerves. Pain scores and opioid consumption were recorded by blinded assessors. Appropriate parametric and nonparametric tests, including repeated-measures analyses, were applied.
RESULTS
Time to first opioid administration was longer in the DEX group than in the NO DEX group (13.0±2.1 hour vs 5.2±1.6 hour; p<.0001). Total opioid consumption during the first 48 hours was lower in the DEX group (18.1±3.8 mg vs 27.3±4.4 mg morphine equivalents; p<.0001). NRS pain scores were lower at 8, 12, and 24 hours postoperatively (p<.05). Neurophysiological assessments showed higher postoperative MEP amplitudes and more favorable ENG parameters in the DEX group compared with the NO DEX group; overall postoperative improvement in neurophysiological measures was observed in both groups. No differences in perioperative blood glucose levels or neurological complications were detected.
CONCLUSIONS
In pediatric scoliosis surgery, dexamethasone administered within the fascial plane as an adjuvant to ESPB is associated with prolonged analgesia and reduced opioid requirements without increasing adverse effects. Differences in neurophysiological parameters between groups should be interpreted as associations and may reflect modulation of perioperative conditions rather than a direct neuroprotective effect. Overall postoperative neurophysiological improvement is likely related to surgical scoliosis correction.