Reg Anesth Pain Med. 2018 Feb;43(2):180-185. doi: 10.1097/AAP.0000000000000392.
The aim of this study was to analyze histological nerve toxicity of perineural dexamethasone administration in combination with ropivacaine on mice. Efficacy of perineural dexamethasone in combination with regional anesthesia is clearly demonstrated. However, the safety of this procedure is still a matter of debate.
A sciatic nerve block was performed on 90 mice. Five groups, each containing 18 mice assigned randomly, were used in these experiments: the sham group (isotonic saline solution), R group (perineural ropivacaine), D group (perineural dexamethasone), RDPN group (perineural ropivacaine and perineural dexamethasone), and the RDS group (perineural ropivacaine and systemic dexamethasone). Sensory and motor blocks were evaluated every 30 minutes for 14 hours. Fourteen and 28 days after this procedure, 9 mice in each group were killed for sciatic nerve histological assessment.
No statistical difference was observed between different groups for Wallerian degeneration (P = 0.28 at day 14 and P = 0.22 at day 28) and perineural inflammation (P = 0.9 at day 14). Motor and sensory block durations were tested for each group. A statistical difference was observed for motor block duration between the RDPN group (150 minutes [127-172 minutes]), the RDS group (120 minutes [90-120 minutes]), and the R group (60 minutes [60-90 minutes]). Sensory block duration was also statistically different: 660 minutes (660-720 minutes) in the RDPN group, 480 minutes (427-660 minutes) in RDS group, 330 minutes (240-410) in the R group.
A combination of ropivacaine and perineural dexamethasone allows longer sensory block duration compared with ropivacaine alone or ropivacaine and systemic dexamethasone, without increased neural toxicity.
本研究旨在分析在小鼠中鞘内给予地塞米松联合罗哌卡因的组织神经毒性。鞘内给予地塞米松联合区域麻醉的疗效已得到明确证实。然而，该操作的安全性仍存在争议。
对 90 只小鼠进行坐骨神经阻滞。这些实验共使用了 5 组，每组 18 只，随机分配：假手术组（等渗生理盐水）、R 组（鞘内罗哌卡因）、D 组（鞘内地塞米松）、RDPN 组（鞘内罗哌卡因和鞘内地塞米松）和 RDS 组（鞘内罗哌卡因和全身地塞米松）。在 14 小时内每 30 分钟评估感觉和运动阻滞。在该操作后 14 天和 28 天，每组处死 9 只小鼠进行坐骨神经组织学评估。
各组的沃勒变性（第 14 天 P = 0.28，第 28 天 P = 0.22）和神经周围炎症（第 14 天 P = 0.9）无统计学差异。测试每组的运动和感觉阻滞持续时间。RDPN 组（150 分钟[127-172 分钟]）、RDS 组（120 分钟[90-120 分钟]）和 R 组（60 分钟[60-90 分钟]）的运动阻滞持续时间存在统计学差异。感觉阻滞持续时间也有统计学差异：RDPN 组 660 分钟（660-720 分钟），RDS 组 480 分钟（427-660 分钟），R 组 330 分钟（240-410 分钟）。
与单独使用罗哌卡因或罗哌卡因联合全身地塞米松相比，罗哌卡因联合鞘内地塞米松可延长感觉阻滞持续时间，而不会增加神经毒性。
