Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Departments of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
J Clin Anesth. 2018 Aug;48:51-57. doi: 10.1016/j.jclinane.2018.05.009. Epub 2018 May 9.
To determine whether perineural dexamethasone prolongs peripheral nerve blockade (PNB) when measured objectively; and to determine if a 1 mg and 4 mg dose provide equivalent PNB prolongation compared to PNB without dexamethasone.
Multiple studies have reported that perineural dexamethasone added to local anesthetics (LA) can prolong PNB. However, these studies have relied on subjective end-points to quantify PNB duration. The optimal dose remains unknown. We hypothesized that 1 mg of perineural dexamethasone would be equivalent in prolonging an adductor canal block (ACB) when compared to 4 mg of dexamethasone, and that both doses would be superior to an ACB performed without dexamethasone.
This was a prospective, randomized, double-blind, placebo-controlled equivalency trial involving 85 patients undergoing a unicompartmental knee arthroplasty.
All patients received an ACB with 20 ml of 0.25% bupivacaine with 1:400,000 epinephrine. Twelve patients had 0 mg of dexamethasone (placebo) added to the LA mixture; 36 patients had 1 mg of dexamethasone in the LA; and 37 patients had 4 mg of dexamethasone in the LA.
The primary outcome was block duration determined by serial neurologic pinprick examinations. Secondary outcomes included time to first analgesic, serial pain scores, and cumulative opioid consumption.
The 1 mg (31.8 ± 10.5 h) and 4 mg (37.9 ± 10 h) groups were not equivalent, TOST [Mean difference (95% CI); 6.1 (-10.5, -2.3)]. Also, the 4 mg group was superior to the 1 mg group (p-value = 0.035), and the placebo group (29.7 ± 6.8 h, p-value = 0.011). There were no differences in opioid consumption or time to analgesic request; however, some pain scores were significantly lower in the dexamethasone groups when compared to placebo.
Dexamethasone 4 mg, but not 1 mg, prolonged the duration of an ACB when measured by serial neurologic pinprick exams.
NCT02462148.
客观地衡量时，确定神经周围给予地塞米松是否会延长周围神经阻滞（PNB）；并确定与无地塞米松的 PNB 相比，1mg 和 4mg 剂量是否能提供等效的 PNB 延长。
多项研究报告称，局部麻醉剂（LA）中加入神经周围地塞米松可以延长 PNB。然而，这些研究依赖于主观终点来量化 PNB 持续时间。最佳剂量仍不清楚。我们假设，与 4mg 地塞米松相比，1mg 神经周围地塞米松在延长收肌管阻滞（ACB）方面是等效的，并且两种剂量都优于不使用地塞米松的 ACB。
这是一项前瞻性、随机、双盲、安慰剂对照的等效性试验，涉及 85 名接受单室膝关节置换术的患者。
所有患者均接受单次股神经阻滞，使用 20ml0.25%布比卡因加 1：400000 肾上腺素。12 名患者在 LA 混合物中加入 0mg 地塞米松（安慰剂）；36 名患者在 LA 中加入 1mg 地塞米松；37 名患者在 LA 中加入 4mg 地塞米松。
主要结局是通过连续神经刺痛检查确定的阻滞持续时间。次要结局包括首次镇痛时间、连续疼痛评分和累积阿片类药物消耗。
1mg（31.8±10.5h）和 4mg（37.9±10h）组不等效，TOST[均值差异（95%CI）；6.1（-10.5，-2.3）]。此外，4mg 组优于 1mg 组（p 值=0.035），也优于安慰剂组（29.7±6.8h，p 值=0.011）。阿片类药物消耗或镇痛请求时间无差异；然而，与安慰剂组相比，地塞米松组的一些疼痛评分明显较低。
通过连续神经刺痛检查测量时，地塞米松 4mg 而不是 1mg 延长了 ACB 的持续时间。
NCT02462148。
