Szucs Szilard, Jessop David, Iohom Gabriella, Shorten George D
Department of Anaesthesia, Intensive Care and Pain Medicine/University College Cork, Cork University Hospital, Wilton, Cork, Ireland.
Faculty of Medicine, Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK.
BMC Anesthesiol. 2016 Sep 22;16(1):79. doi: 10.1186/s12871-016-0247-5.
Fractured neck of femur is a common cause of hospital admission in the elderly and usually requires operative fixation. In a variety of clinical settings, preoperative glucocorticoid administration has improved analgesia and decreased opioid consumption. Our objective was to define the postoperative analgesic efficacy of single dose of dexamethasone administered preoperatively in patients undergoing operative fixation of fractured neck of femur.
Institutional ethical approval was granted and written informed consent was obtained from each patient. Patients awaiting for surgery at Cork University Hospital were recruited between July 2009 and August 2012. Participating patients, scheduled for surgery were randomly allocated to one of two groups (Dexamethasone or Placebo). Patients in the dexamethasone group received a single dose of intravenous dexamethasone 0.1 mg kg immediately preoperatively. Patients in the placebo group received the same volume of normal saline. Patients underwent operative fixation of fractured neck of femur using standardised spinal anaesthesia and surgical techniques. The primary outcome was pain scores at rest 6 h after the surgery.
Thirty seven patients were recruited and data from thirty patients were analysed. The groups were similar in terms of patient characteristics. Pain scores at rest 6 h after the surgery (the principal outcome) were lesser in the dexamethasone group compared with the placebo group [0.8(1.3) vs. 3.9(2.9), mean(SD) p = 0.0004]. Cumulative morphine consumption 24 h after the surgery was also lesser in the dexamethasone group [7.7(8.3) vs. 15.1(9.4), mean(SD) mg, p = 0.04].
A single dose of intravenous dexamethasone 0.1 mg kg administered before operative fixation of fractured neck of femur improve significantly the early postoperative analgesia.
ClinicalTrials.gov identifier: NCT01550146 , date of registration: 07/03/2012.
股骨颈骨折是老年人住院的常见原因，通常需要手术固定。在各种临床情况下，术前给予糖皮质激素可改善镇痛效果并减少阿片类药物的使用。我们的目的是确定术前给予单剂量地塞米松对接受股骨颈骨折手术固定患者的术后镇痛效果。
获得机构伦理批准，并获得每位患者的书面知情同意。2009年7月至2012年8月期间，招募了在科克大学医院等待手术的患者。计划进行手术的参与患者被随机分配到两组之一（地塞米松组或安慰剂组）。地塞米松组患者在术前立即静脉注射单剂量地塞米松0.1mg/kg。安慰剂组患者接受相同体积的生理盐水。患者采用标准化的脊髓麻醉和手术技术进行股骨颈骨折手术固定。主要结局是术后6小时的静息疼痛评分。
招募了37名患者，分析了30名患者的数据。两组患者特征相似。与安慰剂组相比，地塞米松组术后6小时的静息疼痛评分（主要结局）更低[0.8(1.3) vs. 3.9(2.9)，平均值(标准差)，p = 0.0004]。地塞米松组术后24小时的吗啡累积消耗量也更低[7.7(8.3) vs. 15.1(9.4)，平均值(标准差)mg，p = 0.04]。
在股骨颈骨折手术固定前给予单剂量静脉注射地塞米松0.1mg/kg可显著改善术后早期镇痛效果。
ClinicalTrials.gov标识符：NCT01550146，注册日期：2012年3月7日。
