静脉注射地塞米松对周围神经阻滞麻醉的影响：双盲随机对照剂量-反应研究
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Effect of intravenous dexamethasone on the anaesthetic characteristics of peripheral nerve block: a double-blind, randomised controlled, dose-response volunteer study
背景与目的
静脉注射地塞米松被认为可以延长周围神经阻滞的持续时间，但其剂量-反应关系尚不清楚。本项志愿者研究旨在评估静脉注射地塞米松对正中神经阻滞时间延长的剂量-反应效应。
方 法
在本项双盲随机对照研究中，18名志愿者接受了两次正中神经阻滞，两次神经阻滞间隔一个药物清除期。其中一次正中神经阻滞的同时注射生理盐水，另一次阻滞时静脉注射地塞米松2mg、4mg或8mg。主要结果是恢复正常针刺感觉的时间。次要结果包括温度感觉定量分析(QST) 监测冷感觉阈值（CDT）恢复时间、温感觉阈值（WDT）恢复时间、冷痛阈值（CPT）恢复时间、热痛阈值（HPT）恢复时间、QST曲线下面积、握力以及不良反应的发生率。
结 果
主要结果（即针刺感觉恢复时间）在注射生理盐水或地塞米松的志愿者中是相似的，与注射剂量无关(P=0.99)。虽然QST曲线下面积显示CDT(0 vs 8 mg, P=0.002) 和WDT均延长(0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001)，但两组之间QST恢复时间相似。在运动恢复或不良反应方面无差异。
结 论
无论剂量大小，静脉注射地塞米松均不能明显延长周围神经阻滞麻醉时间。然而，QST曲线下面积分析显示CDT和WDT延长与剂量无关，其临床意义尚不清楚。
原始文献摘要
Short A, El-Boghdadly K, Clarke H, et al. Effect of intravenous dexamethasone on the anaesthetic characteristics of peripheral nerve block: a double-blind, randomised controlled, dose-response volunteer study.[J]. Br J Anaesth,2020,124(1).
Background: Intravenous dexamethasone is thought to prolong the duration of peripheral nerve block, but the dose-response relationship remains unclear. The aim of this volunteer study was to evaluate the dose-response effect of i.v. dexamethasone on the prolongation of median nerve block.
Methods: In a double-blind, randomised controlled study, 18 volunteer subjects received two median nerve blocks separated by a washout period. One block was conducted alongside an infusion of saline and the other alongside i.v. dexamethasone 2, 4, or 8 mg. The primary outcome was time to return of normal pinprick sensation. Secondary outcomes included thermal quantitative sensory testing (QST) for the time to return of cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), area under QST curves, grip strength, and the incidence of adverse effects.
Results: The primary outcome, time to recovery of pinprick sensation, was similar between volunteers receiving saline or i.v. dexamethasone, regardless of dose (P=0.99). The time to recovery of QST milestones was similar between groups, although area under QST curves indicated prolongation of CDT (0 vs 8 mg, P=0.002) and WDT (0 vs 2 mg, P=0.008; 0 vs 4 mg, P=0.001; 0 vs 8 mg, P<0.001). There was no difference in motor recovery or adverse effects.
Conclusions: Intravenous dexamethasone failed to significantly prolong the duration of pinprick anaesthesia regardless of dose. However, area under QST curve analysis indicated a dose-independent prolongation of CDT and WDT, the clinical significance of which is unclear.
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：冯玉蓉 审校：王贵龙