Jose Riya, Chakravarthy Kalyana, Nair Shalini, Joseph Mathew, Jeyaseelan Visalakshi, Korula Grace
Departments of *Anaesthesiology †Neurological Sciences, Neuro Intensive Care Division ‡Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India.
J Neurosurg Anesthesiol. 2017 Apr;29(2):150-156. doi: 10.1097/ANA.0000000000000272.
The aim of this double-blinded randomized control study was to examine the role of the steroid dexamethasone as an adjuvant to lignocaine and ropivacaine in scalp nerve blocks in adults undergoing supratentorial craniotomy under general anesthesia. We compared the intraoperative anesthetic and postoperative analgesic requirement with and without the addition of dexamethasone to the local anesthetics.
The consented 90 patients were randomized into 2 groups: one group received 8 mg (2 mL) of dexamethasone, whereas the other received 2 mL of normal saline along with the local anesthetics in the scalp nerve block administered soon after induction of general anesthesia. All patients received oral/intravenous dexamethasone perioperatively to decrease cerebral edema. The general anesthetic technique for induction, maintenance, and recovery was standardized in the 2 groups. The primary outcome assessed was the time to administration of the first dose of analgesic postoperatively. The secondary outcomes included intraoperative opioid requirement, time to emergence, and incidence of postoperative nausea and vomiting.
There was no significant difference between the dexamethasone and saline groups with respect to time to first analgesic requirement, intraoperative fentanyl requirements, time to emergence from general anesthesia, and incidence of postoperative nausea and vomiting.
Addition of dexamethasone as an adjuvant to local anesthetics in scalp nerve blocks in the setting of perioperative steroid therapy does not appear to provide any additional benefit with respect to prolongation of the duration of the block.
这项双盲随机对照研究的目的是探讨类固醇地塞米松作为利多卡因和罗哌卡因辅助剂在全身麻醉下行幕上开颅手术的成人头皮神经阻滞中的作用。我们比较了在局部麻醉药中添加和不添加地塞米松时的术中麻醉和术后镇痛需求。
90名同意参与的患者被随机分为2组：一组接受8毫克（2毫升）地塞米松，而另一组在全身麻醉诱导后不久进行的头皮神经阻滞中，在接受局部麻醉药的同时接受2毫升生理盐水。所有患者围手术期均接受口服/静脉注射地塞米松以减轻脑水肿。两组的全身麻醉诱导、维持和苏醒技术均标准化。评估的主要结局是术后首次给予镇痛药的时间。次要结局包括术中阿片类药物需求、苏醒时间以及术后恶心和呕吐的发生率。
地塞米松组和生理盐水组在首次镇痛需求时间、术中芬太尼需求、全身麻醉苏醒时间以及术后恶心和呕吐发生率方面无显著差异。
在围手术期类固醇治疗背景下，在头皮神经阻滞的局部麻醉药中添加地塞米松作为辅助剂，在延长阻滞持续时间方面似乎未提供任何额外益处。
