Reply to Drs Bolin and Wilson

To the Editor: We thank Drs Bolin and Wilson for their letter and thoughtful comments regarding our study. Drs Bolin and Wilson question the dose of dexamethasone that we used (ie, 8 mg) and suggest, based on a recent trial by Liu and colleagues, that a perineural dose as low as 1 mg of dexamethasone can prolong nerve block duration. While these findings are novel and interesting, the lack of difference between the 1-, 2-, and 4-mg doses of perineural dexamethasone in Liu and colleagues’ study can be directly attributed to the lack of statistical power for detecting significant differences between these 3 groups. Drs Bolin andWilson also cite a small trial of 34 (not 39) patients by Kawanishi and colleagues, wherein intravenous, but not perineural, dexamethasone was deemed responsible for the prolongation of blockrelated analgesia. Unfortunately, this trial similarly lacks sufficient power to support its conclusions. While we agree with Drs Bolin and Wilson that all of the questions regarding perineural versus intravenous dexamethasone are still not answered, we believe that our study is a methodologically robust and important step in the right direction toward finding the answer.