静脉内地塞米松和神经周围地塞米松同样延长锁骨上臂丛阻滞后的镇痛持续时间：一项随机、三臂、双盲、安慰剂对照试验。

Intravenous dexamethasone and perineural dexamethasone similarly prolong the duration of analgesia after supraclavicular brachial plexus block: a randomized, triple-arm, double-blind, placebo-controlled trial.

机构信息

From the Departments of Anesthesia at *St. Michael's Hospital and †Toronto Western Hospital; and University of Toronto, Toronto, Ontario, Canada.

出版信息

Reg Anesth Pain Med. 2015 Mar-Apr;40(2):125-32. doi: 10.1097/AAP.0000000000000210.

DOI:10.1097/AAP.0000000000000210

PMID:25629321

Abstract

BACKGROUND AND OBJECTIVES

Perineural dexamethasone prolongs the duration of single-injection peripheral nerve block when added to the local anesthetic solution. Postulated systemic mechanisms of action along with theoretical safety concerns have prompted the investigation of intravenous dexamethasone as an alternative, with decidedly mixed results. We aimed to confirm that addition of intravenous dexamethasone will prolong the duration of analgesia after single-injection supraclavicular block compared with conventional long-acting local anesthetic alone or in combination with perineural dexamethasone for ambulatory upper extremity surgery.

METHODS

Seventy-five patients were randomized to receive supraclavicular block using 30-mL bupivacaine 0.5% alone (Control), with concomitant intravenous dexamethasone 8 mg (DexIV), or with perineural dexamethasone 8 mg (DexP). Duration of analgesia was designated as the primary outcome. To test our hypothesis, the superiority of DexIV was first compared with Control and then with DexP. Motor block duration, pain scores, opioid consumption, opioid-related side effects, patient satisfaction, and block-related complications were also analyzed.

RESULTS

Twenty-five patients per group were analyzed. The duration of analgesia (mean [95% confidence interval]) was prolonged in the DexIV group(25 hours [17.6–32.4]) compared with Control (13.2 hours [11.5–15.0]; P < 0.001) but similar to the DexP group (25 hours[19.5–30.5]; P = 1). [corrected] Both DexIV and DexP had reduced pain scores, reduced postoperative opioid consumption, and improved satisfaction compared with Control.

CONCLUSIONS

In a single-injection supraclavicular block with long-acting local anesthetic, the effectiveness of intravenous dexamethasone in prolonging the duration of analgesia seems similar to perineural dexamethasone.

摘要

背景与目的

在局部麻醉溶液中加入神经周围地塞米松可延长单次外周神经阻滞的持续时间。作用的推测全身机制以及理论上的安全问题促使人们研究静脉内地塞米松作为替代药物，结果截然不同。我们旨在证实，与单独使用长效局部麻醉剂或与神经周围地塞米松联合使用相比，静脉内地塞米松可延长单次锁骨上阻滞的镇痛持续时间，用于门诊上肢手术。

方法

75 名患者随机分为三组：单独接受 30 毫升 0.5%布比卡因（对照组）、同时接受 8 毫克静脉内地塞米松（DexIV）或同时接受 8 毫克神经周围地塞米松（DexP）的锁骨上阻滞。镇痛持续时间为主要结局。为了检验我们的假设，首先将 DexIV 的优越性与对照组进行比较，然后与 DexP 进行比较。还分析了运动阻滞持续时间、疼痛评分、阿片类药物消耗、阿片类药物相关副作用、患者满意度和阻滞相关并发症。

结果

每组 25 例患者进行分析。与对照组（13.2 小时[11.5-15.0]）相比，DexIV 组（25 小时[17.6-32.4]）的镇痛持续时间延长（P <0.001），但与 DexP 组相似（25 小时[19.5-30.5]）；P = 1）。与对照组相比，DexIV 和 DexP 均降低了疼痛评分、减少了术后阿片类药物消耗，并提高了满意度。