地塞米松作为周围神经阻滞的佐剂：一项随机、三盲交叉研究
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Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised, triple-blinded crossover study in volunteers
背景与目的
目前尚无研究报道，地塞米松可延长局部神经阻滞持续时间。此次针对自愿者的随机、对照、三盲的交叉研究旨在证实这一假设，即地塞米松静脉或者周围神经给药均不能延长罗哌卡因神经阻滞的持续时间。
方 法
采用超声引导下尺神经阻滞(罗哌卡因0.75%wt/vol，3ml，加生理盐水1ml，加或不加地塞米松4 mg)，对24名男性志愿者进行3次尺神经阻滞，注射生理盐水1ml，加或不加4mg地塞米松。根据生理盐水和地塞米松的组合方式不同将患者分为以下几组：对照组，周围神经和静脉均注射生理盐水；周围神经组，在周围神经使用地塞米松，静脉使用生理盐水；静脉组，周围神经使用生理盐水，静脉使用地塞米松。根据针刺试验，用VAS测量感觉神经阻滞。感觉阻滞持续时间为主要观察指标，感觉阻滞起效时间为次要观察指标。
结 果
24名受试者均完成了此次试验。感觉阻滞持续时间的中位数[四分位数间距（IQR）]分别为对照组6.87(5.85-7.62)h、周围神经组7.37 (5.78-7.93)h、静脉组7.37 (6.10-7.97)h (P=0.61)。三组神经阻滞的起效时间无显著性差异。
结 论
4mg地塞米松对罗哌卡因用于尺神经感觉阻滞的持续时间无影响。
原始文献摘要
Marhofer Peter,Columb Malachy,Hopkins Phil M，et al. Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised, triple-blinded crossover study in volunteers.[J] .Br J Anaesth, 2019, 122: 525-531.
Background: The effificacy of dexamethasone in extending the duration of local anaesthetic block is uncertain. In a randomised controlled triple blind crossover study in volunteers, we tested the hypothesis that neither i.v. nor perineurally administered dexamethasone prolongs the sensory block achieved with ropivacaine.
Methods: Ultrasound-guided ulnar nerve blocks (ropivacaine 0.75% wt/vol, 3 ml, with saline 1 ml with or without dexamethasone 4 mg) were performed on three occasions in 24 male volunteers along with an i.v. injection of saline 1 ml with or without dexamethasone 4 mg. The combinations of saline and dexamethasone were as follows: control group, perineural and i.v. saline; perineural group, perineural dexamethasone and i.v. saline; i.v. group, perineural saline and i.v. dexamethasone. Sensory block was measured using a VAS in response to pinprick testing. The duration of sensory block was the primary outcome and time to onset of sensory block the secondary outcome.
Results: All 24 subjects completed the trial. The median [inter-quartile range (IQR)] duration of sensory block was 6.87 (5.85e7.62) h in the control group, 7.37 (5.78e7.93) h in the perineural group and 7.37 (6.10e7.97) h in the i.v. group (P¼0.61). There was also no signifificant difference in block onset time between the three groups.
Conclusion: Dexamethasone 4 mg has no clinically relevant effect on the duration of sensory block provided by ropivacaine applied to the ulnar nerve.
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
