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However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta\u2010analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long\u2010acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2\u2010h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One\u2010hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366\u2013435) min, motor block duration of 369 (330\u2013408) min and analgesic duration of 435 (386\u2010483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160\u2013795) min], followed by perineural dexamethasone [411 (343\u2013480) min] and perineural dexmedetomidine [284 (235\u2013333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236\u2013352) min], followed by intravenous dexamethasone [289 (129\u2013448)min] and perineural dexmedetomidine [258 (212\u2013304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448\u2013589) min], followed by intravenous dexamethasone [478 (277\u2013679) min] and perineural dexmedetomidine [318 (266\u2013371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.<\/jats:p>","DOI":"10.1111\/anae.15288","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T02:40:07Z","timestamp":1603939207000},"page":"974-990","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["Perineural and intravenous dexamethasone and dexmedetomidine: network meta\u2010analysis of adjunctive effects on supraclavicular brachial plexus block"],"prefix":"10.1111","volume":"76","author":[{"given":"H.","family":"Sehmbi","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Peri\u2010operative Medicine London Health Sciences Centre University of Western Ontario London ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Brull","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Toronto Western Hospital University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. R.","family":"Ceballos","sequence":"additional","affiliation":[{"name":"Department of Anesthesia University of Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U. J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Peri\u2010operative Medicine London Health Sciences Centre University of Western Ontario London ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Peri\u2010operative Medicine London Health Sciences Centre University of Western Ontario London ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Tobias","sequence":"additional","affiliation":[{"name":"Tommy's National Centre for Miscarriage Research Institute of Metabolism and Systems Research College of Medical and Dental Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Solo","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre, University of Western Ontario London ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. W.","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Ottawa Hospital Research Institute University of Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,28]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3182176f70"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000000222"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H421"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002488"},{"key":"e_1_2_6_7_1","volume-title":"Cochrane Methods","author":"Higgins J","year":"2016"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1143"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-13"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2005.06.006"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-018-0483-0"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197107222850405"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0091-3057(97)00523-6"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001888-198711000-00014"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1501500403"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1501500402"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1187"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6001"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0099682"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6001"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.03.016"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-016-1583-7"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1044"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6188"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(97)00049-8"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(00)00242-0"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5630"},{"key":"e_1_2_6_31_1","unstructured":"\u2018Summary of findings\u2019 tables in network meta\u2010analysis (NMA) \u2010 Cochrane Training.https:\/\/training.cochrane.org\/resource\/\u2018summary-findings\u2019-tables-network-meta-analysis-nma(accessed 8\/10\/2018)."},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.10.005"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000210"},{"key":"e_1_2_6_34_1","article-title":"Effect of dexamethasone added to lignocaine and bupivacaine mixture for supraclavicular brachial plexus block. 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