Salerno Angelo, Hermann Robert
J Bone Joint Surg Am. 2006 Jun;88(6):1361-72. doi: 10.2106/JBJS.D.03018.
Despite the availability of various analgesic regimens, patient surveys have indicated that moderate-to-severe postoperative pain is still poorly managed. The use of corticosteroids for postoperative pain relief, although popular, has yet to gain wider acceptance because of concerns over side effects, in particular adrenal suppression, osteonecrosis, impaired wound-healing, and concerns about efficacy. The medical literature provides evidence that should substantially decrease these concerns with regard to low and short-dose applications. The results of randomized trials have shown low, short-dose corticosteroid regimens to be safe and effective for reducing postoperative pain. There is strong, grade-A evidence supporting the use of corticosteroids in multimodal analgesia protocols to contribute to the postoperative recovery of the patient by minimizing opioid doses and therefore side effects. However, the optimal mode, dose, and timing of administration remain unclear.
尽管有各种镇痛方案可供选择，但患者调查表明，中重度术后疼痛仍未得到有效控制。使用皮质类固醇缓解术后疼痛虽然很普遍，但由于担心副作用，特别是肾上腺抑制、骨坏死、伤口愈合受损以及对疗效的担忧，尚未得到更广泛的认可。医学文献提供的证据表明，对于低剂量和短疗程应用，这些担忧应会大幅减少。随机试验结果表明，低剂量、短疗程皮质类固醇方案在减轻术后疼痛方面安全有效。有强有力的A级证据支持在多模式镇痛方案中使用皮质类固醇，通过减少阿片类药物剂量从而减少副作用，促进患者术后恢复。然而，最佳给药方式、剂量和时间仍不明确。
