单次静脉注射地塞米松对罗哌卡因腋路臂丛神经阻滞持续时间的影响：随机安慰剂对照试验
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Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial.
背景与目的
静脉注射地塞米松对罗哌卡因腋路臂丛神经阻滞持续时间的影响尚不清楚。本研究旨在探讨静脉注射地塞米松对上肢远端手术患者术后臂丛阻滞镇痛时间的影响。
方 法
本研究为前瞻性、随机、安慰剂、双盲对照试验，患者知情同意后，符合标准的患者被随机分为两组。在患者接受臂丛阻滞时，5-10s内静脉注射8mg/2mL地塞米松（为Dexa组）或者2mL生理盐水（为对照组）；主要指标为神经阻滞后首次使用镇痛剂的时间。次要指标包括：运动或感觉阻滞持续时间、术后镇痛药物的总使用量和相关并发症。
结 果
本试验共纳入98例患者，Dexa组和对照组分别有6例和2例患者不需要术后镇痛（p=0.06）。Dexa组首次进行镇痛药物时间明显长于对照组（20.9±9.3h vs.14.7±6.6h，P<0.0004）,运动和感觉恢复明显迟于对照组，Dexa组的镇痛药物总消耗量低于对照组。未发现静脉注射地塞米松相关的神经并发症。
结 论
行罗哌卡因腋路臂丛神经阻滞时，单次静脉注射地塞米松可延迟上肢手术术后患者首次需要镇痛药物的时间（6小时）。本研究表明静脉注射地塞米松可为腋路臂丛神经阻滞提供良好的“佐剂作用”。
原始文献摘要
Clement Jean-Christophe, Besch Guillaume, Puyraveau Marc et al. Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial. [J] .Reg Anesth Pain Med, 2019, 44: 370–374.
BACKGROUND :
The effect of intravenous dexamethasone on the duration of axillary plexus block performed using ropivacaine is not described. The aim of this study is to assess the effect of intravenous dexamethasone on the duration of axillary plexus block analgesia after distal upper arm surgery.
METHODS:
In this prospective, randomized, placebo-controlled, double-blinded trial, consenting patients scheduled for hand or forearm surgery under ultrasound-guided axillary plexus block performed using 0.5 mL/kg of 0.475% ropivacaine, were randomized to receive an intravenous injection of either 8 mg/2 mL of dexamethasone (Dexa group) or 2 mL of saline (Control). The primary outcome was the time of first analgesic intake after axillary block. Secondary outcomes included motor or sensory block duration, total use of postoperative analgesics, and block-related complications.
RESULTS:
Among the 98 patients included, 6 and 2 patients did not require postoperative analgesic intake in Dexa and Control groups, respectively (p=0.06). The time of first analgesic intake was significantly longer in the Dexa (20.9±9.3 hours) than in the Control group (14.7±6.6 hours, p<0.0004). Motor and sensory recovery occurred significantly later, and total analgesic consumption was lower in the Dexa than in the Control group. No nerve complication related to intravenous dexamethasone injection was recorded.
CONCLUSIONS:
This study showed that intravenous dexamethasone delayed for 6 hours the time to first analgesic intake after upper arm surgery under axillary plexus block performed with the long-lasting local anesthetic ropivacaine. This suggests that intravenous dexamethasone could be an interesting adjuvant to axillary plexus block.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：王贵龙 编辑：何幼芹 审校：王贵龙