Corticosteroids in regional anaesthesia and analgesia - state of the art

Optimisation of postoperative pain control plays an important role in the outcome of surgery. Various adjuncts have been studied in an attempt to enhance the effect of single injection local anaesthetic peripheral nerve blockade, with varying results. Perineural steroids appear to prolong the duration of analgesia after peripheral nerve blockade with local anaesthetics. Other benefits include decreased perioperative opioid use and nausea. The largest number of data is about dexamethasone. However, corticosteroids are not currently licensed for perineural use in Europe and USA. In spite of the fact, the drug is still widely used for this unlicensed indication. Nowadays. spinal epidural steroid injection is the most used interventional pain practice in the management of both neck pain and low back pain. It is a useful technique in pain management of herniated discs. radicular pain and spinal stenosis. Targeted steroid application to the point of pain origin may be beneficial. providing short-term or medium-term effect. Proper patient selection and timing of the procedure are essential for adequate pain relief. Serious adverse effects of corticosteroid injection are rare but can be fatal. Principles of safe spinal interventional procedures have to be adhered to. In order to reduce the rate of fatal complications we recommend using non-particulate steroids and giving a test dose first. Real-time imaging is necessary during every single spinal steroid injection.