Vermeylen Kris, De Puydt Joris, Engelen Stefan, Roofthooft Eva, Soetens Filiep, Neyrinck Arne, Van de Velde Marc
Department of Anesthesia and Intensive Care, AZ Turnhout, Turnhout, Belgium.
Department of Anesthesia, University Hospital Antwerp, Antwerp, Belgium.
Local Reg Anesth. 2016 May 5;9:17-24. doi: 10.2147/LRA.S96073. eCollection 2016.
A popliteal block is effective in managing postoperative pain for foot surgery, but since the duration of analgesia is limited following a single-shot popliteal fossa block technique, methods to prolong effective postoperative analgesia are mandatory. The aim of this study was to assess the effect of adjuvants to ropivacaine on the duration of sensory and motor block.
In this double-blind randomized placebo-controlled study, we evaluated the analgesic effect of clonidine or dexamethasone (DXM) when added to ropivacaine for hallux valgus surgery. After obtaining institutional ethics research board approval and written informed consent, a total of 72 patients were randomly allocated. Fifty-seven of these patients were statistically analyzed. All patients received an ultrasound-guided single-shot popliteal fossa block with 30 mL of ropivacaine 0.75%, supplemented with saline, clonidine 100 µg, or DXM 5 mg. The primary end point was time to first pain sensation. Secondary end points were time to complete sensory and motor block regression.
Compared to saline, duration to first pain sensation was prolonged by 9 hours (mean ± standard deviation: 31±9 hours) (42%) in the DXM group (P=0.024) and by 6 hours (28±10 hours) (27%) in the clonidine group (P=0.024). Compared to saline, DXM prolonged both complete sensory and motor blockade by 12 hours (25±7 hours) (46%) and 13 hours (36±6 hours) (55%), respectively, while clonidine prolonged complete sensory and motor blockade by 7 hours (30±7 hours) (27%) and 2 hours (22±5 hours) (10%), respectively. DXM prolonged sensory block regression time by 6 hours (21±7 hours) (41%) and clonidine by 2 hours (17±6 hours) (13%) compared to the control group (P=0.006). Similarly, DXM prolonged motor block regression by 7 hours (25±7 hours) (46%) and clonidine by 4 hours (21±4 hours) (19%) (P<0.0001).
Addition of DXM and clonidine to ropivacaine significantly prolonged the duration of postoperative sensory and motor block.
腘窝阻滞对足部手术术后疼痛的管理有效，但由于单次腘窝阻滞技术后的镇痛持续时间有限，延长术后有效镇痛的方法是必要的。本研究的目的是评估罗哌卡因佐剂对感觉和运动阻滞持续时间的影响。
在这项双盲随机安慰剂对照研究中，我们评估了可乐定或地塞米松（DXM）添加到罗哌卡因用于拇外翻手术时的镇痛效果。获得机构伦理研究委员会批准并取得书面知情同意后，共72例患者被随机分配。其中57例患者进行了统计学分析。所有患者均接受超声引导下单次腘窝阻滞，注射30 mL 0.75%罗哌卡因，并分别补充生理盐水、100 μg可乐定或5 mg DXM。主要终点是首次出现疼痛感觉的时间。次要终点是感觉和运动阻滞完全消退的时间。
与生理盐水相比，DXM组首次出现疼痛感觉的持续时间延长了9小时（平均±标准差：31±9小时）（42%）（P = 0.024），可乐定组延长了6小时（28±10小时）（27%）（P = 0.024）。与生理盐水相比，DXM分别使感觉和运动阻滞完全消退时间延长了12小时（25±7小时）（46%）和13小时（36±6小时）（55%），而可乐定分别使感觉和运动阻滞完全消退时间延长了7小时（30±7小时）（27%）和2小时（22±5小时）（10%）。与对照组相比，DXM使感觉阻滞消退时间延长了6小时（21±7小时）（41%），可乐定延长了2小时（17±6小时）（13%）（P = 0.006）。同样，DXM使运动阻滞消退时间延长了7小时（25±7小时）（46%），可乐定延长了4小时（21±4小时）（19%）（P < 0.0001）。
罗哌卡因中添加DXM和可乐定可显著延长术后感觉和运动阻滞的持续时间。
