Zhu Change, Zhang Saiji, Gu Zhiqing, Tong Yiru, Wei Rong
Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Paediatr Anaesth. 2018 Mar;28(3):195-203. doi: 10.1111/pan.13338.
Dexamethasone has become a popular additive for regional anesthesia. The aim of this meta-analysis was to assess the effectiveness of this additive on the duration of postoperative analgesia, postoperative vomiting, and possible adverse events in pediatrics.
We searched databases, conference records, and registered trials for randomized controlled trials. The databases included the Cochrane Library, JBI Database of Systematic Reviews, PubMed, ISI Web of Knowledge, Science-Direct, and Embase. Odds ratio, weighted mean difference, and the corresponding 95% confidence intervals were calculated using the REVMAN software, version 5.3, for data synthesis and statistical analysis, which following the PRISMA statement. The main outcomes were duration of postoperative analgesia (time from the end of surgery to first administration of analgesics as evidenced by a pain score) and postoperative vomiting.
Seven studies were selected for this meta-analysis, involving 647 pediatric patients. All the patients were randomized to receive caudal or intravenous dexamethasone with caudal block (experimental group) or plain caudal block (control group). There was significantly longer duration of postoperative analgesia in the experimental group compared with control group (weighted mean difference: 238.40 minutes; 95% CI: 193.41-283.40; P < .00001). The experimental group had fewer patients who needed analgesics after surgery (odds ratio: 0.18 minutes; 95% CI: 0.05-0.66; P = .009). Additionally, the number of subjects who remained pain-free to 2, 6, 24, and 48 hours after operation was significantly greater in the experimental group than control group. Side effects in these 2 groups were comparable (odds ratio: 0.94; 95% CI: 0.34-2.56; P = .90). The incidence of postoperative vomiting was significantly decreased in the experimental group compared with control group (odds ratio: 0.29; 95% CI: 0.13-0.63; P = .002).
Caudal and intravenous dexamethasone could provide longer duration of postoperative analgesia and reduced the incidence of postoperative vomiting with comparable adverse effects than plain caudal block. However, any additive to the caudal space carries with it the potential for neurotoxicity and that caution should always be exercised when weighting the risks and benefits of any additive. The result was influenced by small numbers of participants and significant heterogeneity.
地塞米松已成为区域麻醉中常用的添加剂。本荟萃分析的目的是评估这种添加剂对小儿术后镇痛持续时间、术后呕吐及可能的不良事件的有效性。
我们检索了数据库、会议记录和注册试验以查找随机对照试验。数据库包括Cochrane图书馆、JBI系统评价数据库、PubMed、科学网、Science-Direct和Embase。使用REVMAN 5.3软件计算比值比、加权平均差及相应的95%置信区间，用于数据合成和统计分析，遵循PRISMA声明。主要结局为术后镇痛持续时间（从手术结束至首次使用镇痛药的时间，以疼痛评分证明）和术后呕吐。
本荟萃分析选取了7项研究，涉及647例儿科患者。所有患者被随机分为接受骶管或静脉注射地塞米松联合骶管阻滞（试验组）或单纯骶管阻滞（对照组）。与对照组相比，试验组术后镇痛持续时间显著更长（加权平均差：238.40分钟；95%置信区间：193.41 - 283.40；P <.00001）。试验组术后需要镇痛药的患者更少（比值比：0.18分钟；95%置信区间：0.05 - 0.66；P =.009）。此外，试验组术后2、6、24和48小时无痛的受试者数量显著多于对照组。这两组的副作用相当（比值比：0.94；95%置信区间：0.34 - 2.56；P =.90）。与对照组相比，试验组术后呕吐的发生率显著降低（比值比：0.29；95%置信区间：0.13 - 0.63；P =.002）。
骶管和静脉注射地塞米松可提供更长的术后镇痛持续时间，并降低术后呕吐的发生率，与单纯骶管阻滞相比不良反应相当。然而，向骶管间隙添加任何物质都有神经毒性的潜在风险，在权衡任何添加剂的风险和益处时应始终谨慎。结果受参与者数量少和显著异质性的影响。
