经皮神经周围给予低剂量地塞米松与全身给予地塞米松相比可延长布比卡因肌间沟阻滞镇痛作用：一项随机试验。
Perineural Low-Dose Dexamethasone Prolongs Interscalene Block Analgesia With Bupivacaine Compared With Systemic Dexamethasone: A Randomized Trial.
机构信息
From the Department of Anesthesiology.
Healthcare Research Institute, and.
出版信息
Reg Anesth Pain Med. 2018 Aug;43(6):572-579. doi: 10.1097/AAP.0000000000000817.
BACKGROUND AND OBJECTIVES
Perineural dexamethasone and intravenous (IV) dexamethasone have been shown to prolong peripheral nerve block duration. The effects of perineural and IV dexamethasone have only been compared at doses of 4 mg or greater. This triple-blind, randomized trial examined the effect of 1 mg IV versus perineural dexamethasone on interscalene block (ISB) analgesia duration.
METHODS
Patients undergoing ambulatory shoulder arthroscopy received an ultrasound-guided ISB with 15 mL bupivacaine 0.5% and 1 mg preservative-free dexamethasone that was administered perineurally (PeriD) or IV (IVDex). All patients received IV ketorolac and were discharged on naproxen 500 mg 2 times a day plus oxycodone/acetaminophen as needed. Peripheral nerve block duration, pain, opioid consumption, and block satisfaction were assessed via telephone follow-ups.
RESULTS
There were 63 PeriD patients and 62 IVDex patients who completed the primary outcome follow-up. The median time until analgesia from the ISB completely wore off was 3.5 hours (95% confidence interval, 1.0-6.0 hours) longer in the PeriD versus IVDex groups; P = 0.007). Time until the pain relief from the ISB began to wear off was also longer in the PeriD versus IVDex group (5.5 hours [95% confidence interval, 2.1-9.0 hours]; P = 0.002). Other secondary outcomes, including opioid consumption, satisfaction, and pain scores, were not different between groups.
CONCLUSIONS
In patients undergoing shoulder arthroscopy, low-dose perineural dexamethasone (1 mg) in combination with 15 mL of 0.5% bupivacaine prolonged the median time until pain relief from the ISB completely wore off compared with 1 mg IV dexamethasone. However, the degree of prolongation was smaller than the a priori-defined minimal clinically meaningful difference of 5 hours.
CLINICAL TRIAL REGISTRATION
This study was registered at Clinicaltrials.gov, identifier NCT02506660.
背景与目的
已证实，外周神经鞘内给予地塞米松和静脉内（IV）给予地塞米松均可延长周围神经阻滞的持续时间。仅在 4mg 或更大剂量时比较过外周神经鞘内和 IV 地塞米松的作用。本三盲、随机试验研究了 1mg IV 与外周神经鞘内地塞米松对肩胛上神经阻滞（ISB）镇痛持续时间的影响。
方法
接受日间肩关节镜检查的患者接受超声引导下 ISB，使用 15ml 0.5%布比卡因和 1mg 无防腐剂地塞米松，通过外周神经鞘内（PeriD）或静脉内（IVDex）给予。所有患者均接受 IV 酮咯酸，并出院时给予萘普生 500mg，每日 2 次，必要时给予羟考酮/对乙酰氨基酚。通过电话随访评估外周神经阻滞持续时间、疼痛、阿片类药物消耗和阻滞满意度。
结果
完成主要结局随访的 PeriD 患者有 63 例，IVDex 患者有 62 例。从 ISB 完全失效到出现疼痛的中位时间在 PeriD 组比 IVDex 组长 3.5 小时（95%置信区间，1.0-6.0 小时）；P = 0.007）。从 ISB 开始缓解疼痛到疼痛开始缓解的时间在 PeriD 组也比 IVDex 组长 5.5 小时（95%置信区间，2.1-9.0 小时）；P = 0.002）。其他次要结局，包括阿片类药物消耗、满意度和疼痛评分，两组间无差异。
结论
在接受肩关节镜检查的患者中，与 1mg IV 地塞米松相比，联合 0.5%布比卡因 15ml 时，外周神经鞘内给予低剂量地塞米松（1mg）可延长 ISB 完全失效后疼痛缓解的中位时间，与预先设定的 5 小时的最小临床有意义差异相比，延长程度较小。
临床试验注册
本研究在 Clinicaltrials.gov 上注册，标识符为 NCT02506660。
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