肌间沟臂丛阻滞神经周围注射地塞米松的剂量-反应关系:随机、对照、三盲试验
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Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple-blind trial
背景与目的
神经周围注射地塞米松的上限剂量为4mg，以延长注射长效局麻药阻滞周围神经后的镇痛持续时间，但地塞米松剂量<4mg时对局麻药镇痛时间的影响缺乏有效证据。
方 法
本项随机对照三盲试验旨在验证一个假设，即神经周围注射地塞米松的剂量在1 mg~4 mg之间递增时，会呈剂量依赖性延长镇痛时间。80例ASA分级1-2级拟在全身麻醉及超声引导臂丛神经阻滞下行肩关节镜检查的患者，随机分别注射生理盐水（对照组）加0.5%罗哌卡因20 ml、地塞米松1 mg加0.5%罗哌卡因20 ml、地塞米松2 mg加0.5%罗哌卡因20 ml、地塞米松3 mg加0.5%罗哌卡因20 ml和地塞米松4 mg加0.5%罗哌卡因20 ml。术后镇痛药物包括对乙酰氨基酚、双氯芬酸和羟考酮，根据要求使用预先设定的方案。主要观察结果是镇痛持续时间，定义为完成阻滞到第一次要求使用镇痛药之间的时间。次要观察结果包括静息和动态疼痛评分，以及术后2h、24h和48h的镇痛药使用量。使用多重比较程序模型分析剂量-反应关系。
结 果
镇痛持续时间中位数 (IQR [range])呈剂量依赖性显著延长：对照组685 min(590–860 [453–1272])、地塞米松1mg组835 min(740–1110 [450–1375])、地塞米松2mg组904 min (710–1130 [525–1365])、地塞米松3mg组965 min(875–1025 [730–1390])、地塞米松4mg组1023 min (838–1239 [518–1500]) (p = 0.03)。次要结果之间没有显著差异。
结 论
与罗哌卡因联合应用于肌间沟臂丛阻滞，神经周围给药剂量在1 mg~4 mg之间时，地塞米松呈剂量依赖性延长镇痛持续时间。
原始文献摘要
Albrecht E, Reynvoet M, Fournier N, et al. Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple-blind trial.[J]. Anaesthesia 2019 Apr 11. DOI：10.1111/anae.14650.
Perineural dexamethasone has a ceiling dose of 4 mg for prolongation of analgesia duration after injection of long-acting local anaesthetic for peripheral nerve block, but evidence for doses < 4 mg is lacking. This randomised controlled triple-blind trial tested the hypothesis that increasing doses of perineural dexamethasone between 1 mg and 4 mg would prolong the duration of analgesia in a dose-dependent manner. Eighty ASA physical status 1–2 patients scheduled for shoulder arthroscopy under general anaesthesia with ultrasound-guided interscalene brachial plexus block were randomly allocated to receive saline (control), dexamethasone 1 mg, 2 mg, 3 mg and 4 mg, together with 20 ml ropivacaine 0.5%. Postoperative analgesia consisted of paracetamol, diclofenac and oxycodone on request, using a pre-defifined protocol. The primary outcome was the duration of analgesia, defifined as the time between the block procedure and the fifirst analgesic request. Secondary outcomes included rest and dynamic pain scores, and analgesic consumption at 2 h, 24 h and 48 h postoperatively. An analysis of the dose–response relationship was performed using multiple comparison procedure-modelling. The median (IQR [range]) duration of analgesia was signifificantly prolonged in a dose-dependent manner: control 685 (590–860 [453–1272]) min; 1 mg 835 (740–1110 [450–1375]) min; 2 mg 904 (710–1130 [525–1365]) min; 3 mg 965 (875–1025 [730–1390]) min; 4 mg 1023 (838–1239 [518–1500]) min (p = 0.03). There were no signifificant differences between the secondary outcomes. Perineural administration of dexamethasone with doses between 1 mg and 4 mg, combined with ropivacaine for interscalene brachial plexus block, prolongs duration of analgesia in a dose-dependent manner.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙