Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Pediatric Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Paediatr Anaesth. 2021 Jun;31(6):665-675. doi: 10.1111/pan.14178. Epub 2021 Mar 23.
Dexamethasone added to incision-site infiltration has been routinely used to reduce pain after tonsillectomy in children. However, this has not been studied in pediatric craniotomy patients yet. We hypothesized that incision-site infiltration with a combination of ropivacaine and dexamethasone might provide superior analgesia to ropivacaine alone in pediatric craniotomy patients.
In this multicenter, double-blind, randomized, controlled trial, children aged 2-12 years, scheduled for craniotomy, were prospectively enrolled at two study centers, from September 2, 2019, to July 5, 2020. Eighty children were randomly assigned (1:1) to either ropivacaine plus dexamethasone group who received pre-emptive incision-site infiltration with 0.2% ropivacaine plus 0.025% dexamethasone, or ropivacaine group who received 0.2% ropivacaine alone. Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at 24 h postoperatively. Primary analysis was performed using the modified intention-to-treat principle.
Pre-emptive incision-site infiltration with ropivacaine plus dexamethasone had a reduced pain score of 2.0, compared with the pain score of 2.9 in the ropivacaine group, at 24 h postoperatively (mean difference -0.9, 95% confidence interval [CI], -1.7 to -0.2; p = .019). Estimated median of the time of first rescue analgesic demand was 24 h in the ropivacaine plus dexamethasone group and 8.5 h in the ropivacaine group [hazard ratio 0.43, 95% CI 0.24 to 0.08; Log-rank p = .0025]. No adverse events related to incision-site infiltration with dexamethasone were observed in this study.
Dexamethsone reduces the local production of pro-inflammatory factors after tissue damage and as a ropivacaine adjuvant for incision-site infiltration reduced the pain scores by 31% at 24 h postoperatively. The results were similar to several prior studies on to tonsillectomy patients. However, this changes on pain scores might has limited clinical significance.
The addition of dexamethasone to ropivacaine for preoperative incision-site infiltration has better postoperative analgesic effect than ropivacaine alone in pediatric craniotomy patients.
在儿童中，常规使用地塞米松加切口部位浸润以减轻扁桃体切除术后的疼痛。然而，尚未在儿科开颅术患者中对此进行研究。我们假设，与单独使用罗哌卡因相比，罗哌卡因和地塞米松联合使用切口部位浸润可能会为儿科开颅术患者提供更好的镇痛效果。
在这项多中心、双盲、随机、对照试验中，2019 年 9 月 2 日至 2020 年 7 月 5 日，在两个研究中心前瞻性招募了年龄 2-12 岁、计划行开颅术的儿童。将 80 名儿童随机（1:1）分配至罗哌卡因加地塞米松组（接受术前切口部位浸润 0.2%罗哌卡因加 0.025%地塞米松）或罗哌卡因组（接受 0.2%罗哌卡因）。主要结局是术后 24 小时的改良儿童东部安大略省疼痛量表（mCHEOPS）。主要分析采用修改后的意向治疗原则进行。
与罗哌卡因组的 2.9 相比，罗哌卡因加地塞米松的术前切口部位浸润的疼痛评分降低至 2.0（平均差值 -0.9，95%置信区间 [CI]，-1.7 至 -0.2；p=0.019）。罗哌卡因加地塞米松组首次需要解救性镇痛的估计中位时间为 24 小时，罗哌卡因组为 8.5 小时[风险比 0.43，95%CI 0.24 至 0.08；对数秩检验 p=0.0025]。在这项研究中，没有观察到与地塞米松切口部位浸润相关的不良事件。
地塞米松可减少组织损伤后局部促炎因子的产生，作为罗哌卡因的佐剂，术前切口部位浸润可使术后 24 小时疼痛评分降低 31%。结果与几项先前关于扁桃体切除术患者的研究相似。然而，这种疼痛评分的变化可能具有有限的临床意义。
与单独使用罗哌卡因相比，在儿科开颅术患者中，地塞米松加罗哌卡因用于术前切口部位浸润可获得更好的术后镇痛效果。
