Central Michigan University College of Medicine, CMED Building, 1280 S. East Campus St, Mt. Pleasant, MI, 48859, USA.
West Suffolk NHS Foundation Trust, Suffolk, England.
Can J Anaesth. 2018 Feb;65(2):194-206. doi: 10.1007/s12630-017-1008-8. Epub 2017 Nov 21.
Dexamethasone is commonly used as an adjuvant to local anesthetics for peripheral nerve blockade; however, uncertainty persists regarding its optimal route of administration and safety. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare the incremental benefits of intravenous (IV) vs perineural (PN) dexamethasone when used as adjuvants for peripheral nerve blockade to improve analgesia.
A search strategy was developed to identify eligible articles from the Cochrane and National Library of Medicine databases from inception until June 2017. The National Center for Biotechnology Information Medical Subject Headings browser thesaurus was used to identify search terms and combinations of keywords. Any clinical trial that randomly allocated adult patients (≥ 18 yr old) to receive either IV or PN dexamethasone for peripheral nerve blockade was considered for inclusion.
After full-text screening of potentially eligible articles, 14 RCTs were included in this review. Overall, the use of PN dexamethasone did not provide a significant incremental benefit to the duration of analgesia [ratio of means (ROM), 1.23; Hartung-Knapp-Sidik-Jonkman (HKSJ) 95% confidence interval (CI), 0.85 to 1.85; P = 0.23] or to motor block duration (ROM, 1.14; HKSJ 95% CI, 0.98 to 1.31; P = 0.07). Also, at 24-hr follow-up, there was no significant difference between the two groups regarding pain scores (standardized mean difference, 0.36; HKSJ 95% CI, -0.08 to 0.80; I = 75%; P = 0.09) and cumulative opioid consumption (mean difference, 5.23 mg; HKSJ 95% CI, -4.60 to 15.06; P = 0.15). Lastly, no long-term nerve-related complications were observed with the use of PN dexamethasone.
The results of our meta-analysis suggest that PN and IV dexamethasone provide equivalent analgesic benefits and have similar safety profiles, when used as adjuvants, for peripheral nerve blockade.
地塞米松常用于外周神经阻滞的局部麻醉辅助药物；然而，其最佳给药途径和安全性仍存在不确定性。本系统评价和荟萃分析纳入了随机对照试验（RCT），旨在比较静脉（IV）和神经周围（PN）给予地塞米松作为外周神经阻滞辅助药物以改善镇痛效果的增量获益。
制定了一种检索策略，以从 Cochrane 和美国国立医学图书馆数据库中检索从建库开始至 2017 年 6 月期间的合格文章。使用国家生物技术信息中心医学主题词浏览器词库来确定检索词和关键词组合。任何将成年患者（≥18 岁）随机分配接受 IV 或 PN 地塞米松用于外周神经阻滞的临床试验均被认为符合纳入标准。
在对潜在合格文章进行全文筛选后，纳入了 14 项 RCT 进行本综述。总体而言，PN 地塞米松的使用并不能显著延长镇痛持续时间[均数比（ROM），1.23；Hartung-Knapp-Sidik-Jonkman（HKSJ）95%置信区间（CI），0.85 至 1.85；P=0.23]或运动阻滞持续时间（ROM，1.14；HKSJ 95%CI，0.98 至 1.31；P=0.07）。此外，在 24 小时随访时，两组间疼痛评分（标准化均数差，0.36；HKSJ 95%CI，-0.08 至 0.80；I²=75%；P=0.09）和累积阿片类药物消耗量（均数差，5.23mg；HKSJ 95%CI，-4.60 至 15.06；P=0.15）均无显著差异。最后，未观察到使用 PN 地塞米松引起的长期神经相关并发症。
本荟萃分析结果表明，PN 和 IV 地塞米松作为外周神经阻滞辅助药物时，提供了等效的镇痛效果，且安全性相似。
