Bakeer Ahmed H, Abdallah Nasr M, Kamel Mahmoud A, Abbas Dina N, Ragab Ahmed S
Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt,
Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt.
J Pain Res. 2018 Dec 19;12:61-67. doi: 10.2147/JPR.S181788. eCollection 2019.
The study aimed at the evaluation of the impact of intravenous (IV) dexamethasone on efficacy and duration of analgesia of paravertebral block (PVB) in patients undergoing modified radical mastectomy (MRM).
This randomized, double-blind controlled trial included 50 patients with breast cancer scheduled for unilateral MRM. Ultrasound-guided PVB was performed in out-of-plane technique. The technique was repeated at each segment from C7 to T6. The participants were randomly allocated to one of two groups. Group BD (n=25) received IV 8 mg dexamethasone diluted with 8 mL of normal saline to reach 10 mL solution, while Group B received IV 10 mL normal saline. Top-up local infiltration analgesia into the surgical field was performed by the surgeon if needed using lidocaine 1% intraoperatively. Propofol infusion of 50-100 µg/kg/min was maintained throughout the surgery. The time to administration of the first postoperative analgesic dose, pain intensity as visual analog scale (VAS) score, number of patients who required rescue morphine analgesia, total morphine consumption, postoperative nausea and vomiting (PONV) impact scale, and the overall satisfaction of patients with pain management were measured.
Fifty patients were randomized and analyzed. The time to first rescue analgesic dose was significantly longer in Group DB (<0.001). The VAS scores were significantly lower in Group DB compared to Group B up to 12 hours postoperatively. Morphine consumption was lower in Group DB compared to Group B. PONV Impact Scale score was significantly higher in Group B.
Systemic dexamethasone increased the efficacy and duration of the single-shot multilevel PVB in breast cancer surgery.
ISRCTN registry, study ID: ISRCTN15920148.
本研究旨在评估静脉注射地塞米松对接受改良根治性乳房切除术（MRM）患者的椎旁阻滞（PVB）镇痛效果和持续时间的影响。
这项随机、双盲对照试验纳入了50例计划行单侧MRM的乳腺癌患者。采用平面外技术进行超声引导下的PVB。从C7至T6的每个节段重复该技术。参与者被随机分配到两组中的一组。BD组（n = 25）接受静脉注射用8 mL生理盐水稀释的8 mg地塞米松，配制成10 mL溶液，而B组接受静脉注射10 mL生理盐水。如有需要，外科医生在术中使用1%利多卡因对手术区域进行补充局部浸润镇痛。整个手术过程中维持丙泊酚50 - 100 μg/kg/min的输注速度。记录首次术后镇痛剂量的给药时间、视觉模拟量表（VAS）评分的疼痛强度、需要补救性吗啡镇痛的患者数量、吗啡总消耗量、术后恶心呕吐（PONV）影响量表以及患者对疼痛管理的总体满意度。
50例患者被随机分组并进行分析。DB组首次补救性镇痛剂量的给药时间显著延长（<0.001）。术后12小时内，DB组的VAS评分显著低于B组。DB组的吗啡消耗量低于B组。B组的PONV影响量表评分显著更高。
全身性地塞米松提高了乳腺癌手术中单次多级PVB的镇痛效果和持续时间。
ISRCTN注册库，研究编号：ISRCTN15920148。
