Background/Objectives: The pericapsular nerve group (PENG) block is increasingly used as part of multimodal analgesia for total hip arthroplasty (THA). However, standard high-volume local anesthetic regimens may impair motor function. The addition of perineural dexamethasone could allow for volume reduction while maintaining analgesic efficacy and minimizing quadriceps weakness. This study evaluated whether adding dexamethasone to a low-volume PENG block prolongs analgesia, reduces opioid consumption, maintains pain control, and preserves motor function compared to a standard-volume PENG block. Materials and Methods: In this randomized controlled trial (NCT06470334), 60 adult patients undergoing THA via the direct superior approach received either a standard-volume PENG block with 20 mL of 0.2% ropivacaine (PENG group) or a low-volume block with 10 mL of 0.2% ropivacaine plus 4 mg of perineural dexamethasone (PENG + DEX group). The primary outcome was time to first rescue opioid. Secondary outcomes included total 48-h opioid consumption (oral morphine equivalents), pain scores (numeric rating scale, NRS) at rest and during movement, and quadriceps muscle strength at predefined postoperative intervals. Results: The PENG + DEX group demonstrated a significantly longer time to first opioid administration (15.0 ± 1.5 h vs. 9.1 ± 1.7 h; p < 0.0001) and reduced total opioid consumption within 48 h (2.3 ± 3.1 mEQ vs. 5.0 ± 4.4 mEQ; p = 0.0120). Pain scores were similar at 4 h but significantly lower in the PENG + DEX group at 8, 12, and 24 h postoperatively (all p < 0.01). Quadriceps strength was fully preserved in both groups at all assessed timepoints (p > 0.9999). Conclusions: The addition of perineural dexamethasone to a low-volume PENG block provides longer-lasting analgesia and reduces opioid requirements without compromising pain control or quadriceps function. This approach may improve the safety and efficacy of regional anesthesia in THA.

Background: Supraclavicular brachial plexus block is a widely used technique for upper limb surgery in children. Although perineural dexamethasone has demonstrated efficacy in prolonging analgesia in adults, data on its optimal dosing and systemic safety in pediatric patients are limited. This study aimed to evaluate whether low-dose perineural dexamethasone can prolong postoperative analgesia without increasing systemic stress markers in young children undergoing hand or wrist surgery. Methods: In this triple-blinded, randomized controlled trial (ClinicalTrials.gov Identifier: NCT06086392), 90 children aged 3 months to 6 years undergoing elective upper extremity surgery were assigned to receive supraclavicular brachial plexus block with 0.2% ropivacaine combined with either normal saline (control), dexamethasone 0.05 mg/kg, or dexamethasone 0.1 mg/kg. The primary outcome was time from arrival in the postanesthesia care unit to first administration of rescue opioid analgesia. Secondary outcomes included total opioid consumption, postoperative pain intensity using the FLACC scale, blood glucose levels, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and time to motor recovery. Results: Both dexamethasone groups demonstrated significantly prolonged time to first opioid use compared with the control group (mean±SD: 19.4±2.2 h in the 0.1 mg/kg group, 16.0±1.9 h in the 0.05 mg/kg group, and 8.5±1.3 h in controls; P <0.0001). Total opioid consumption was significantly reduced in the dexamethasone groups. Postoperative pain scores were lower in both intervention groups, especially during the first 12 hours. No significant differences were found among groups in blood glucose, inflammatory markers, or incidence of nerve deficits. Motor recovery was delayed in the dexamethasone groups but did not interfere with early mobilization. Conclusions: Low-dose perineural dexamethasone (0.05 to 0.1 mg/kg) safely and effectively prolongs postoperative analgesia and reduces opioid needs in children undergoing upper limb surgery, without causing systemic metabolic or inflammatory disturbances. The 0.05 mg/kg dose may offer a more favorable balance between analgesic efficacy and motor recovery time. Level of Evidence: Level I—randomized controlled trial.

Total hip arthroplasty (THA) is associated with significant postoperative pain, which can impair early mobilization and recovery. Erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique for lower limb surgeries. However, the duration of single-shot ESPB is limited. This study aimed to assess the effect of perineural dexamethasone as an adjunct to ropivacaine in prolonging analgesia and reducing opioid requirements in patients undergoing THA. In this randomized, quadruple-blinded, controlled trial, 60 patients aged ≥65 years scheduled for elective THA under spinal anesthesia were assigned to receive ultrasound-guided ESPB with either 20 mL of 0.2 % ropivacaine plus 2 mL saline (control group) or 20 mL of 0.2 % ropivacaine plus 4 mg perineural dexamethasone (dexamethasone group). The primary outcome was time to first rescue opioid analgesia. Secondary outcomes included total opioid consumption, Numerical Rating Scale (NRS) pain scores, motor strength, nerve safety, and blood glucose levels over 48 h postoperatively. The dexamethasone group showed a significantly prolonged time to first opioid use (16.0 ± 1.3 vs. 8.9 ± 1.7 h; p < 0.0001) and reduced opioid consumption (3.5 ± 4.8 vs. 19.2 ± 12.2 MME; p < 0.0001). NRS scores were consistently lower beyond the 4-h time point. No motor deficits, nerve injuries, or hyperglycemia were observed. Perineural dexamethasone significantly enhances the analgesic efficacy of ESPB in THA without compromising safety. This simple adjunct offers substantial benefit in postoperative pain control and opioid reduction.

Orthopedic procedures trigger a complex inflammatory response that plays a central role in tissue repair and postoperative recovery. However, excessive or dysregulated inflammation may contribute to complications such as periprosthetic joint infection, thromboembolic events, delayed healing, or systemic organ dysfunction. Therefore, accurate perioperative monitoring of inflammatory activity has become increasingly important in orthopedic surgery. Evidence discussed in this review was identified through a literature search of PubMed, Scopus, and Web of Science databases covering publications from 2000 to 2026. This narrative review summarizes the current evidence regarding both traditional inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and D-dimers, as well as emerging biomarkers derived from complete blood count (CBC), such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI). Particular attention is devoted to the clinical utility of these biomarkers in orthopedic trauma, fracture healing, total joint arthroplasty, and the early detection of postoperative complications. Increasing evidence suggests that composite CBC-derived indices may provide a practical and cost-effective approach for perioperative risk stratification and prognosis assessment. Nevertheless, their interpretation remains challenging due to the lack of standardized cutoff values and the influence of multiple patient-related factors. Current evidence indicates that assessing biomarker kinetics and interpreting multiple inflammatory indices together may be more clinically valuable than isolated measurements. Future research should focus on standardization, validation in prospective studies, and integration of inflammatory biomarkers into personalized perioperative care pathways in orthopedic surgery.

Background: Postoperative pain control after pediatric hand surgery remains challenging despite the increasing use of regional anesthesia. This randomized triple-blind trial evaluated whether adjunctive intravenous dexamethasone prolongs postoperative opioid-free analgesia after pediatric supraclavicular brachial plexus block. Methods: Ninety children undergoing elective hand or wrist surgery were randomized to receive intravenous placebo, dexamethasone 0.1 mg/kg, or dexamethasone 0.2 mg/kg before ultrasound-guided supraclavicular brachial plexus block (30 patients/group). The primary outcome was time to first postoperative opioid administration within 48 hours. Secondary outcomes included opioid consumption, postoperative pain scores, time to first documented spontaneous finger movement, and adverse events. Results: Intravenous dexamethasone significantly prolonged postoperative opioid-free analgesia compared with placebo. Median time to first rescue opioid administration was 8.9 hours in the placebo group, 14.3 hours in the dexamethasone 0.1 mg/kg group, and 17.3 hours in the dexamethasone 0.2 mg/kg group ( P <0.0001). Patients receiving dexamethasone also demonstrated lower postoperative opioid consumption and lower pain scores during the 48-hour follow-up period. The time to first documented spontaneous finger movement was delayed in dexamethasone-treated patients. No serious adverse events were observed. Conclusions: Adjunctive intravenous dexamethasone prolonged opioid-free analgesia and reduced postoperative opioid requirements after pediatric hand surgery. Although analgesic outcomes improved in a dose-dependent manner, higher dexamethasone doses were associated with longer time to first documented spontaneous finger movement. Level of Evidence: Level I—therapeutic study.