Areeruk Pornpatra, Ittichaikulthol Wichai, Termpornlert Sivaporn, Pravitharangul Thanist, Nganlasom Jitpattra, Charoensap Chonticha, Tongjunjuar Kasinee
J Med Assoc Thai. 2016 Nov;99(11):1239-44.
Acute postoperative pain is associated with many undesirable outcomes. Opioids are the mainstay for pain relief but their common side effects are still problematic. Many adjunctive agents such as NSAIDs and gabapentin have already been proved to be effective as multimodal analgesia. Dexamethasone has been reported to reduce postoperative nausea and vomiting but the analgesic effect is not well defined especially in open abdominal surgery.
To evaluate efficacy of a single perioperative dose of dexamethasone on postoperative pain in gynecological laparotomy surgery.
A prospective, randomized, double-blinded study was approved by the Institutional Review Board and registered with the Thai Clinical Trials Registry as TCTR20151116001. Fifty-two patients scheduled for elective gynecological laparotomy surgery were enrolled in the present study. Patients were randomized into two groups based on computer generated random number list. After induction, group D received intravenous dexamethasone 8 mg and group P received saline. Both groups were anesthetized in a standardized manner. Postoperative pain was managed with intravenous morphine using patient controlled analgesia. The primary outcome was total morphine consumption evaluated at 6- and 24-hour postoperatively. Pain score, nausea, and vomiting, shivering, sore throat, and adverse effects of dexamethasone were also recorded.
The total dose of morphine (0 to 24 hour after surgery) was less in D group (15.88±9.59 mg) compared with P group (24.25±15.26 mg) (p = 0.027). The doses during hour 0 to 6 were smaller in D group (11.28±6.66 mg) than the placebo (15.79±12.50) (p = 0.435). The numerical rating scale for pain at rest did not differ in both study groups, but pain in motion was less in D group than P group at 6-hour (p = 0.03) and 24-hour (p = 0.039) after surgery. No adverse effect was observed in both groups.
A single perioperative dose 8 mg of dexamethasone is safe and significantly reduces pain at movement and morphine consumption in 24 hours after gynecological laparotomy surgery.
急性术后疼痛与许多不良后果相关。阿片类药物是缓解疼痛的主要药物，但其常见副作用仍然存在问题。许多辅助药物，如非甾体抗炎药和加巴喷丁，已被证明作为多模式镇痛有效。据报道，地塞米松可减少术后恶心和呕吐，但镇痛效果尚未明确，尤其是在开腹手术中。
评估围手术期单次剂量地塞米松对妇科剖腹手术术后疼痛的疗效。
一项前瞻性、随机、双盲研究经机构审查委员会批准，并在泰国临床试验注册中心注册为TCTR20151116001。本研究纳入了52例计划进行择期妇科剖腹手术的患者。根据计算机生成的随机数字列表将患者随机分为两组。诱导后，D组静脉注射地塞米松8mg，P组静脉注射生理盐水。两组均采用标准化方式麻醉。术后疼痛采用静脉注射吗啡的患者自控镇痛进行管理。主要结局是术后6小时和24小时评估的吗啡总消耗量。还记录了疼痛评分、恶心、呕吐、寒战、咽痛以及地塞米松的不良反应。
D组（15.88±9.59mg）术后24小时内吗啡总剂量低于P组（24.25±15.26mg）（p = 0.027）。D组术后0至6小时的剂量（每11.28±6.66mg）低于安慰剂组（15.79±12.50mg）（p = 0.435）。两组静息时的数字疼痛评分量表无差异，但术后6小时（p = 0.03）和24小时（p = 0.039）时，D组活动时的疼痛低于P组。两组均未观察到不良反应。
围手术期单次剂量8mg地塞米松安全，可显著减轻妇科剖腹手术后24小时内活动时的疼痛并减少吗啡消耗量。
