Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Reg Anesth Pain Med. 2010 Sep-Oct;35(5):422-6. doi: 10.1097/AAP.0b013e3181e85eb9.
Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery.
After Federal Health Department and institutional review board approval, 45 adult patients undergoing elective hand or forearm surgery under supraclavicular brachial plexus blockade were randomized to receive either 30 mL mepivacaine 1.5% plus dexamethasone 8 mg (4 mg/mL), or 30 mL mepivacaine 1.5% plus 2 mL normal saline. The primary outcome measure was duration of analgesia. Secondary outcomes included onset times of sensory and motor blockade, pain and satisfaction scores, analgesic consumption, and block-related complications.
Patient characteristics were similar between groups. The median duration of analgesia was significantly prolonged in the Dexamethasone group (332 mins; interquartile range, 225-448 mins) compared with the Normal Saline group (228 mins; interquartile range, 207-263 mins; P = 0.008). The onset times of sensory and motor block were similar between the groups. Complications were minor and transient and did not differ between groups at 2 weeks postoperatively.
The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.
皮质类固醇成功地用于延长周围神经和硬膜外阻滞后局部麻醉药的作用持续时间。我们假设，在超声引导锁骨上臂丛阻滞下，向甲哌卡因中加入地塞米松将延长接受上肢手术的患者的镇痛持续时间。
在联邦卫生部和机构审查委员会批准后，45 名接受锁骨上臂丛阻滞下择期手部或前臂手术的成年患者被随机分为接受 30 mL 1.5%甲哌卡因加 8 mg 地塞米松（4 mg/mL）或 30 mL 1.5%甲哌卡因加 2 mL 生理盐水。主要观察指标为镇痛持续时间。次要观察指标包括感觉和运动阻滞的起效时间、疼痛和满意度评分、镇痛药物消耗和与阻滞相关的并发症。
两组患者的特征相似。地塞米松组的镇痛持续时间中位数明显延长（332 分钟；四分位间距，225-448 分钟），而生理盐水组为 228 分钟（四分位间距，207-263 分钟；P=0.008）。两组感觉和运动阻滞的起效时间相似。并发症轻微且短暂，术后 2 周时两组之间无差异。
与单独使用甲哌卡因相比，在超声引导锁骨上阻滞下，向甲哌卡因中加入地塞米松可延长镇痛持续时间，但不会降低感觉和运动阻滞的起效时间。
