地塞米松对腹腔镜下妇科手术中腹横肌平面阻滞镇痛效果的影响：一项前瞻性随机临床研究
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Effect of dexamethasone on analgesic efficacy of transverse abdominis plane block in laparoscopic gynecological procedures: A prospective randomized clinical study
背景与目的
地塞米松已越来越多地被用作周围神经阻滞中局部麻醉药的辅助药物，各种研究表明，阿片类药物不影响静脉注射（iv）地塞米松的作用，也不影响多模式镇痛技术。地塞米松的这种作用是由于它的外周作用还是由于它的全身吸收作用尚不清楚。在我们的研究中，我们对地塞米松在腹横肌平面阻滞中作为局部麻醉药的辅助用药与在全麻下腹腔镜外科手术患者中仅通过静脉注射与阻滞处理的效果进行了比较。
方 法
这是一项前瞻性，随机，平行，双盲研究。主要结果是第一次进行镇痛管理的时间。采用计算机随机数字表法将40名患者随机分配到PN组和IV组，并且使用密封不透明信封分配。全麻诱导后，PN组接受超声引导下双侧TAP阻滞，每侧给予15ml 0.25%的左布比卡因和4mg（1ml）地塞米松。IV组接受双侧TAP阻滞，每侧给予15ml 0.25%的左布比卡因和静脉给予8mg地塞米松。
结 果
PN组首次镇痛要求时间为6.63±1.5 h，静脉组为5.04±1.7 h。两组的疼痛评分具有可比性。
结 论
地塞米松的两种使用途径都对0.25%左布比卡因TAP阻滞镇痛质量有一定的影响。
原始文献摘
Parasuraman Vetriselvan, Banashree Mandal, Nidhi Bhatia,et，al.Effect of dexamethasone on analgesic efficacy of transverse abdominis plane block in laparoscopic gynecological procedures: A prospective randomized clinical study[J] J Anaesthesiol Clin Pharmacol 2019 Apr-Jun;35(2) DOI：10.4103/joacp.JOACP_374_17 .
Background and Aims: Dexamethasone has been increasingly used as an adjuvant to local anesthetics in peripheral nerve blocks with various studies showing an opioid sparing the effect of intravenous (IV) dexamethasone as well in a multimodal analgesia technique. It is not clear whether this effect of dexamethasone is because of its peripheral action or because of its systemic absorption. In our study, we compared the effectiveness of dexamethasone on duration of analgesia when used as an adjuvant with local anesthetic in transverse abdominis plane block (TAP) versus when given systemically by IV route along with block only, in patients undergoing laparoscopic gynecological procedures under general anesthesia (GA).
Material and Methods: This is a prospective, randomized, parallel treatment, double‑blinded study. The primary outcome of our study was the time to administration of first rescue analgesia. Forty patients were randomly assigned to perineural (PN) and IV Group using a computer‑generated random numbers table and allocated using sealed opaque envelopes technique. After induction of GA, PN group received ultrasound guided TAP block with 15 ml of 0.25% levobupivacaine plus 4 mg (1 ml) dexamethasone on each side. Patients in IV group received TAP block on both sides with 15 ml of 0.25% levobupivacaine and 8 mg IV dexamethasone.
Results: Time to request for first rescue analgesia was 6.63 ± 1.5 h in PN group and 5.04 ± 1.7 h in IV group. Pain scores were comparable in both the groups.
Conclusion: Dexamethasone administered in either of the routes has comparative effect on quality of analgesia of TAP block with 0.25% levobupivacaine.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：何幼芹 审校：王贵龙