Nielsen Rikke Vibeke, Fomsgaard Jonna, Mathiesen Ole, Dahl Jørgen Berg
Department of Neuroanaesthesiology, Rigshospitalet, Glostrup University Hospital, Nordre Ringvej 57, 2600, Glostrup, Denmark.
Department of Neuroanaesthesiology, Rigshospitalet, Glostrup University Hospital, Glostrup, Denmark.
BMC Anesthesiol. 2016 Nov 16;16(1):112. doi: 10.1186/s12871-016-0277-z.
It has been hypothesized that dexamethasone can inhibit persistent postoperative pain, but data on humans is lacking and results from animal studies are conflicting. We explored the effect of 16 mg dexamethasone IV administered preoperatively on persistent pain 1 year after lumbar discectomy.
This is a prospective 1-year follow-up on a single-centre, randomized, and blinded trial exploring the analgesic effect of 16 mg IV dexamethasone or placebo after lumbar discectomy. One year follow-up was a written questionnaire including back and leg pain (VAS 0-100 mm), Short Form 36 survey (SF-36), EuroQol 5D (EQ-5D), OSWESTRY Low Back Pain Questionnaire, duration of sick leave, working capability, contentment with surgical result.
Response rate was 71% (55 patients) in the dexamethasone group, 58% (44 patients) in the placebo group. Leg pain (VAS) was significantly lower in the placebo group compared to the dexamethasone group: 17 (95% CI 10-26) vs 26 (95% CI 19-33) mm, respectively (mean difference 9 mm (95% CI -1 to 0), (P = 0.03). No difference regarding back pain. The placebo group reported significantly more improvement of leg pain and were significantly more satisfied with the surgical result. Patients in the dexamethasone group reported significantly higher pain levels in EQ-5D- and Oswestry questionnaires. No difference in the SF-36 survey or daily analgesic consumption.
We found significantly higher pain levels in the dexamethasone group compared to placebo 1 year after lumbar disc surgery.
Clinicaltrials.gov ( NCT01953978 ). Registered 26 Sep 2013.
有假说认为地塞米松可抑制术后持续性疼痛，但缺乏人体数据，且动物研究结果相互矛盾。我们探讨了术前静脉注射16毫克地塞米松对腰椎间盘切除术后1年持续性疼痛的影响。
这是一项单中心、随机、双盲试验的前瞻性1年随访研究，旨在探讨腰椎间盘切除术后静脉注射16毫克地塞米松或安慰剂的镇痛效果。1年随访采用书面问卷，内容包括腰腿痛（视觉模拟评分法，0 - 100毫米）、36项简短健康调查（SF - 36）、欧洲五维健康量表（EQ - 5D）、奥斯威斯利腰痛问卷、病假时长、工作能力、对手术结果的满意度。
地塞米松组的应答率为71%（55例患者），安慰剂组为58%（44例患者）。与地塞米松组相比，安慰剂组的腿痛（视觉模拟评分法）明显更低：分别为17（95%置信区间10 - 26）毫米和26（95%置信区间19 - 33）毫米（平均差值9毫米（95%置信区间 - 1至0），P = 0.03）。腰痛方面无差异。安慰剂组报告腿痛改善更明显，且对手术结果的满意度更高。地塞米松组患者在EQ - 5D和奥斯威斯利问卷中的疼痛水平明显更高。在SF - 36调查或每日镇痛药物消耗量方面无差异。
我们发现腰椎间盘手术后1年，地塞米松组的疼痛水平明显高于安慰剂组。
Clinicaltrials.gov（NCT01953978）。于2013年9月26日注册。
