【罂粟摘要】术前使用塞米松对全膝关节置换术后疼痛的缓解作用：随机对照试验
术前用地塞米松对全膝关节置换术后疼痛的缓解作用：随机对照试验
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
皮质类固醇可以减轻疼痛，但最佳剂量和安全性仍不确定。
本研究旨在评价两种不同剂量的地塞米松在全膝关节置换术后的止痛效果及其副作用。
前瞻性随机对照试验。
香港一所高等教学医院。
146名患者，随机分为三组。
D8组、D16组和P组术前分别给予地塞米松8mg、地塞米松16mg和0.9%生理盐水安慰剂。
主要结果是术后疼痛评分。次要观察指标是阿片类药物的消耗、膝盖的物理参数（膝关节的活动范围(用测角仪测量屈伸角度）、股四头肌功能）和地塞米松的副作用。
与安慰剂相比，D16组患者术后第3天最大主动屈曲时疼痛明显减轻[-1.3(95%CI，2.2~0.31)，P=0.005]。疼痛评分与地塞米松剂量之间也有显著的剂量依赖性趋势(P=0.002)。与安慰剂相比，D16组患者使用的阿片类药物明显减少[-6.4 mg (95% CI, -11.6 to -1.2), P=0.025]，股四头肌肌力明显增强(P<0.0 5)。术后第1天步行距离明显延长 [7.8 m ([95% CI, 0.85 to 14.7),P=0.023]，术后前两天步行辅助较少(均P<0.029)，术后第1天恢复质量评分明显高于对照组(P=0.018))。上述参数与地塞米松剂量之间均有明显的剂量依赖性趋势(均P<0.05)。术后3个月、6个月、12个月慢性疼痛和膝关节功能的发生率无明显差异。
全膝关节置换术前给予地塞米松16 mg，术后疼痛减轻，阿片类药物用量减少，股四头肌肌力增强，活动能力增强，术后总体恢复质量好。在减轻慢性疼痛和膝关节功能方面没有发现长期的改善。
Preoperative dexamethasone for pain relief after total knee arthroplasty：A randomised controlled trial
BACKGROUND: Corticosteroids can reduce pain but the optimal dose and safety profiles are still uncertain.
OBJECTIVE: This study aimed to evaluate two different doses of dexamethasone for pain management and their side effects after total knee arthroplasty.
DESIGN: A prospective randomised, controlled trial.
SETTING: A tertiary teaching hospital in Hong Kong.
PATIENTS: One hundred and forty-six patients were randomly allocated to one of three study groups.
INTERVENTIONS: Before operation, patients in group D8,D16 and P received dexamethasone 8 mg, dexamethasone 16 mg and placebo (0.9% saline), respectively.
MAIN OUTCOME MEASURES: The primary outcome was postoperative pain score. Secondary outcomes were opioid consumption, physical parameters of the knees and side effects of dexamethasone.
RESULTS: Compared with placebo, group D16 patients had significantly less pain during maximal active flexion on post-operative day 3[-1.3(95%CI，2.2~0.31)，P=0.005].There was also a significant dose-dependent trend between pain scores and dexamethasone dose (P=0.002). Compared with placebo, patients in group D16 consumed significantly less opioid [-6.4 mg (95% CI, -11.6 to -1.2), P=0.025] and had stronger quadriceps power on the first three postoperative days (all P<0.05). They also had significantly longer walking distance on postoperative day 1 [7.8 m ([95% CI, 0.85 to 14.7),P=0.023] with less assistance during walking on the first two postoperative days (all P<0.029) and significantly better quality-of-recovery scores on postoperative day 1 (P=0.018). There were significant dose-dependent trends between all the above parameters and dexamethasone dose (all P<0.05). No significant differences were found in the incidence of chronic pain or knee function 3, 6 and 12 months postoperatively.
CONCLUSION: Dexamethasone 16 mg given before total knee arthroplasty led to a reduction in postoperative pain, less opioid consumption, stronger quadriceps muscle power, better mobilisation and better overall quality-of-recovery after operation. No long-term improvement in reduction in pain and function of the knee was found.
翻译：牛振瑛
编辑：佟睿
审校：曹莹
贵州医科大学高鸿教授课题组