Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
Anesth Analg. 2012 Apr;114(4):813-22. doi: 10.1213/ANE.0b013e318247f628. Epub 2012 Feb 17.
We performed a systematic review to assess the efficacy of dexamethasone in reducing postoperative nausea, vomiting (PONV), pruritus, and enhancing postoperative analgesia in patients receiving neuraxial anesthesia with neuraxial morphine.
We searched Medline (1966-2011), the Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science for all randomized controlled trials comparing dexamethasone with placebo for the prevention of PONV and/or pruritus in patients receiving neuraxial morphine as part of a neuraxial anesthetic technique. Data were extracted independently by the authors on the incidence of PONV, pruritus, pain scores at 4 and 24 hours, and use of rescue antiemetics, antipruritics, and analgesics.
Eight randomized controlled trials (4 cesarean deliveries, 4 total abdominal hysterectomies) were included. From these trials, 768 patients were analyzed with 473 receiving dexamethasone and 295 receiving placebo. The doses of dexamethasone investigated ranged from 2.5 to 10 mg. Dexamethasone reduced the incidence of postoperative nausea (relative risk, RR [95% confidence interval, CI] = 0.57 [0.45, 0.72]), vomiting (RR [95% CI] = 0.56 [0.43, 0.72]), and the use of rescue antiemetic therapy (RR [95% CI] = 0.47 [0.36, 0.61]) compared with placebo. There was no evidence of dose responsiveness with respect to its antiemetic effect. Dexamethasone also reduced 24-hour visual analog pain scores (measured on an 11-point scale [0-10]) (mean difference [95% CI] = -0.30 [-0.46, -0.13]) and the use of rescue analgesics (RR [95% CI] = 0.72 [0.52, 0.98]). Dexamethasone did not reduce the incidence of pruritus (RR [95% CI] = 0.98 [0.84, 1.15]). Examination of the funnel plots and Egger's test revealed evidence of publication bias in the primary outcomes.
Dexamethasone is an effective antiemetic for patients receiving neuraxial morphine for cesarean delivery and abdominal hysterectomy. In addition, the doses used for antiemetic prophylaxis enhanced postoperative analgesia compared with placebo. However, dexamethasone was not effective for the prophylaxis against neuraxial morphine-induced pruritus.
我们进行了一项系统评价，以评估地塞米松在接受鞘内吗啡的脊麻患者中减少术后恶心、呕吐（PONV）、瘙痒和增强术后镇痛的疗效。
我们检索了 Medline（1966-2011）、Cochrane 对照试验中心注册库、EMBASE 和 Web of Science，以查找所有比较地塞米松与安慰剂预防接受鞘内吗啡的脊麻患者 PONV 和/或瘙痒的随机对照试验。作者独立提取 PONV、瘙痒、4 小时和 24 小时疼痛评分以及使用解救性止吐药、止痒药和镇痛药的数据。
纳入了 8 项随机对照试验（4 例剖宫产，4 例全子宫切除术）。这些试验共分析了 768 例患者，其中 473 例接受地塞米松，295 例接受安慰剂。研究的地塞米松剂量为 2.5 至 10mg。地塞米松降低了术后恶心（相对风险，RR [95%置信区间，CI] = 0.57 [0.45, 0.72]）、呕吐（RR [95% CI] = 0.56 [0.43, 0.72]）和使用解救性止吐药治疗（RR [95% CI] = 0.47 [0.36, 0.61]）的发生率。在止吐效果方面，没有证据表明与剂量有关。地塞米松还降低了 24 小时视觉模拟疼痛评分（在 11 分制上测量 [0-10]）（平均差值 [95% CI] = -0.30 [-0.46, -0.13]）和使用解救性镇痛药（RR [95% CI] = 0.72 [0.52, 0.98]）。地塞米松并未降低瘙痒的发生率（RR [95% CI] = 0.98 [0.84, 1.15]）。对漏斗图和 Egger 检验的检查显示，主要结局存在发表偏倚的证据。
地塞米松是接受鞘内吗啡用于剖宫产和全子宫切除术的患者的有效止吐药。此外，用于预防止吐的剂量与安慰剂相比增强了术后镇痛。然而，地塞米松对预防鞘内吗啡引起的瘙痒无效。
