地塞米松和右美托咪定联合腹横肌平面阻滞用于胃癌患者术后镇痛的效果：一项双盲随机对照试验。

Combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane block for postoperative analgesia in gastric cancer patients: A double-blinded randomized controlled trial.

机构信息

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Anesthesiology, Sichuan Science City Hospital, Mianyang, Sichuan 621900, China.

出版信息

J Clin Anesth. 2024 Oct;97:111543. doi: 10.1016/j.jclinane.2024.111543. Epub 2024 Jul 1.

DOI:10.1016/j.jclinane.2024.111543

Abstract

STUDY OBJECTIVE

We conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients.

DESIGN

Randomized controlled trial.

SETTING

The preoperative area, operating room, postanesthesia recovery room and bed ward.

PATIENTS

A total of 312 adult patients (104 per group) with gastric cancer were included.

INTERVENTIONS

Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).

MEASUREMENTS

The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.

MAIN RESULTS

The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04).

CONCLUSIONS

The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.

TRIAL REGISTRATION NUMBER

ChiCTR2000037981.

摘要

研究目的

我们进行了这项双盲随机对照试验，以检验地塞米松和右美托咪定联合作为腹横肌平面（TAP）阻滞的佐剂是否能提高胃癌患者的镇痛效果和持续时间。

设计

随机对照试验。

地点

术前区、手术室、麻醉恢复室和病床区。

患者

共纳入 312 例成年胃癌患者（每组 104 例）。

干预措施

患者接受双侧肋缘下 TAP 阻滞，使用三种不同的麻醉剂（60ml 0.25%罗哌卡因加 10mg 地塞米松和 1μg·kg-1 右美托咪定[A]或 10mg 地塞米松[B]或 1μg·kg-1 右美托咪定[C]）。

测量

主要结局是术后 24 小时运动时中度至重度疼痛的发生率。次要结局包括中度至重度疼痛的发生率、疼痛评分、阿片类药物使用、恢复质量和不良反应。

主要结果

术后 24 小时运动时中度至重度疼痛的发生率，A 组明显低于 B 组（45.19%比 63.46%；RR 0.71；95%CI，0.55 至 0.92）和 C 组（45.19%比 73.08%，RR 0.62；95%CI，0.49 至 0.79）。术后 24 小时（3.00[3.00，5.00]比 4.00[3.00，6.00]比 4.00[3.00，5.00]）的移动疼痛评分中位数显著降低（P<0.001）。术后 24 小时内阿片类药物的消耗有显著差异（27.5[17.0，37.2]比 30.0[20.0，42.0]比 32.0[25.0，44.0]mg；P=0.01）和首次解救镇痛的时间（65.5±26.7比 45.9±34.5比 49.2±27.2 h；P=0.04）。