顶刊带读Let's go!l口服地塞米松对锁骨下臂丛神经阻滞上肢手术后镇痛持续时间的影响：一项随机对照试验

The effect of oral dexamethasone on duration ofanalgesia after upper limb surgery under infraclavicular brachial plexus block: a randomised controlled trial

口服地塞米松对锁骨下臂丛神经阻滞上肢手术后镇痛持续时间的影响：一项随机对照试验

The effects of oral dexamethasone on peripheral nerve blocks have not been investigated. We randomly allocated adults scheduled for forearm or hand surgery to oral placebo (n = 61), dexamethasone 12 mg (n = 61) or dexamethasone 24 mg (n = 58) about 45 min before lateral infraclavicular block. Mean (SD) time until first pain after block were: 818 (219) min; 1171 (318) min; and 1256 (395) min, respectively. Mean (98.3% CI) differences in time until first postoperative pain for dexamethasone 24 mg vs. placebo and vs. dexamethasone 12 mg were: 437 (280–594) min, p < 0.001; and 85 (-78 to 249) min, p = 0.21, respectively. Mean (98.3%CI) difference in time until first postoperative pain for dexamethasone 12 mg vs. placebo was 354 (218–490) min, p < 0.001. Both 24 mg and 12 mg of oral dexamethasone increased the time until first postoperative pain compared with placebo in patients having upper limb surgery under infraclavicular brachial plexus block.

摘要

口服地塞米松对周围神经阻滞的影响尚未进行研究。在锁骨下外侧阻滞前约45分钟，我们将预定接受前臂或手部手术的成人随机分配至口服安慰剂组（n = 61）、地塞米松12 mg组（n = 61）或地塞米松24 mg组（n = 58）。阻滞后至首次疼痛的平均（SD）时间分别为：818（219）min; 1171（318）min;和1256（395）min。地塞米松24 mg组与安慰剂组和地塞米松12 mg组术后首次疼痛时间的平均（98.3% CI）差异分别为：437（280-594）min，p < 0.001;和85（-78至249）min，p = 0.21。地塞米松12 mg组与安慰剂组术后首次疼痛时间的平均差异（98.3%CI）为354（218-490）min，p < 0.001。在锁骨下臂丛神经阻滞的上肢手术患者中，与安慰剂相比，口服地塞米松24 mg和12 mg均延长了至首次术后疼痛的时间。

Mean (SD) times until pain after brachial plexus block were: 818 (292) min with placebo; 1171 (318) min with dexamethasone 12 mg; and 1256 (395) min with dexamethasone 24 mg (Fig. 2). Mean (98.3%CI) differences in time for dexamethasone 24 mg vs. placebo and vs. dexamethasone 12 mg were: 437 (280–594) min, p < 0.001; and 85 (-78 to 249) min, p = 0.21, respectively. Mean (98.3% CI) difference in time until pain after brachial plexus block for dexamethasone 12 mg vs. placebo was 354 (218–490) min, p < 0.001. There were no differences for any of the subgroup analyses (online Supporting Information Appendix S1).

臂丛神经阻滞后疼痛的平均（SD）时间为：安慰剂组818（292）min;地塞米松12 mg组1171（318）min;地塞米松24 mg组1256（395）min（图2）。地塞米松24 mg相对于安慰剂和相对于地塞米松12 mg的平均（98.3%CI）时间差异分别为：437（280-594）min，p < 0.001;和85（-78至249）min，p = 0.21。地塞米松12 mg组与安慰剂组臂丛神经阻滞后疼痛时间的平均差异（98.3% CI）为354（218-490）min，p < 0.001。任何亚组分析均无差异（在线支持性信息附录S1）。

Median (IQR [range]) times to biceps movement after brachial plexus block were: 813 (660–1087 [137–1950]) min with placebo; 1144 (973–1335 [315–2050]) min with dexamethasone 12 mg; and 1144 (915–1325 [193–1635]) with dexamethasone 24 mg. Mean (95%CI) differences in time for dexamethasone 24 mg vs. placebo and vs. dexamethasone 12 mg were: 232 (121–356) min, p < 0.001; and -30 (-149 to 81) min, p = 0.63, respectively. Mean (95%CI) difference in time for dexamethasone 12 mg vs. placebo was 283 (148–394) min, p < 0.001. Quality of sleep was similar in all groups for both postoperative nights (Table 2). Average pain and worst pain during the first 24 h postoperatively were reduced by both doses of dexamethasone compared with placebo (Table 2). Pain at 24 h and 48 h after surgery were similar in all groups, although opioid administration was reduced by both dexamethasone doses (Table 2).

臂丛神经阻滞后肱二头肌运动的中位（IQR [范围]）时间：安慰剂组为813（660-1087 [137-1950]）分钟;地塞米松12 mg组为1144（973-1335 [315-2050]）分钟;地塞米松24 mg组为1144（915-1325 [193-1635]）分钟。地塞米松24 mg组与安慰剂组和地塞米松12 mg组的平均（95%CI）时间差异分别为：232（121-356）分钟，p < 0.001;和-30（-149至81）分钟，p = 0.63。地塞米松12 mg与安慰剂的平均（95%CI）时间差异为283（148-394）min，p < 0.001。两个术后夜晚，所有组的睡眠质量相似（表2）。与安慰剂相比，两种剂量的地塞米松均减轻了术后前24小时内的平均疼痛和最严重疼痛（表2）。尽管两种地塞米松剂量均减少了阿片类药物给药，但所有组在术后24小时和48小时的疼痛相似（表2）。

Suspected acute coronary syndrome was excluded after investigation in two participants, one in each dexamethasone group. One participant in the dexamethasone 24 mg group fell and broke their femur. An operation was redone in one participant in the placebo group whose internal fixation failed. There was no difference in the rates of adverse events (Table 3). On per-protocol analysis, rest pain at 24 h was greater after placebo than after dexamethasone 12 mg or 24 mg: mean (95%CI) difference 1 (0–2) for both, p = 0.034 and p = 0.031, respectively.

在对两名参与者（每个地塞米松组各一名）进行调查后，排除了疑似急性冠状动脉综合征。地塞米松24 mg组的1名受试者跌倒并股骨骨折。安慰剂组中1例内固定失败的参与者接受了再次手术。不良事件的发生率无差异（表3）。在符合方案分析中，安慰剂治疗后24小时静息痛比地塞米松12 mg或24 mg治疗后更严重：两者得平均值（95%CI）差异均为1（0-2），分别为p = 0.034与p = 0.031.

整理/徐宁

排版/叮当丸子麻