Department of Orthopedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Nanning, Guangxi, China.
Guangxi Medical University, Nanning, China.
Pain Physician. 2021 Sep;24(6):E693-E707.
Perineural (PN) dexamethasone (DEX) administration can prolong the analgesic time of a brachial plexus block. However, its efficacy and safety are controversial due to its off-label use and different routes of administration.
This meta-analysis aimed to assess the safety and efficacy of PN versus intravenous (IV) dexamethasone.
Systematic review and meta-analysis of randomized controlled trials (RCTs).
Relevant studies were found through a comprehensive literature search of PubMed, Web of Science, Ovid, EMBASE, and the Cochrane Library (from the inception until January 2020).
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis was conducted to identify RCTs comparing PN and IV dexamethasone in brachial plexus block. A randomized effect model was used in the meta-analysis and the subgroup analysis was performed with adrenaline stratification. The quality of evidence and the strength of recommendations were graded by GradePro version 3.6.1.
Twelve RCTs with a total of 1,345 subjects were included. We found that PN dexamethasone could prolong the duration of analgesia (mean difference [MD]: 131.82 minutes, 95% confidence interval [CI] [38.96, 224.68], I2 = 82%, P = 0.005), motor block (MD: 218.85 minutes, 95% CI [113.65,324.05], I2 = 72%, P < 0.0001) and sensory block (MD: 209.57 minutes, 95% CI [72.64, 346.50], I2 = 87%, P = 0.003) in the main analysis with significant difference. In the absence of epinephrine, there were no significant differences between PN dexamethasone and IV dexamethasone. Except for adverse-effects, no significant differences were observed in secondary outcomes. PN dexamethasone had slightly higher adverse-effects; however, these could be altered if a sensitivity analysis was conducted.
There was high heterogeneity among included studies.
PN dexamethasone can prolong the duration of analgesia, sensory block, and motor block, when compared with IV dexamethasone. In a subgroup analysis without epinephrine, the 2 routes of administration were equivalent to topical anesthesia. There were no differences in secondary outcomes, except for adverse effects, which could be altered if a sensitivity analysis was conducted. Therefore, despite the advantages of PN dexamethasone, caution is needed due to its off-label character. While the results of this study are promising, additional large and well-designed RCTs are needed to validate these initial findings and their implications.
神经周围（PN）地塞米松（DEX）给药可延长臂丛阻滞的镇痛时间。然而，由于其超适应证使用和不同的给药途径，其疗效和安全性存在争议。
本荟萃分析旨在评估 PN 与静脉内（IV）地塞米松的安全性和疗效。
系统评价和随机对照试验（RCT）的荟萃分析。
通过全面检索 PubMed、Web of Science、Ovid、EMBASE 和 Cochrane 图书馆（从成立到 2020 年 1 月），找到了相关研究。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，本荟萃分析旨在确定比较臂丛阻滞中 PN 和 IV 地塞米松的 RCT。采用随机效应模型进行荟萃分析，并进行肾上腺素分层的亚组分析。使用 GradePro 版本 3.6.1 对证据质量和推荐强度进行分级。
纳入了 12 项 RCT，共 1345 名受试者。我们发现 PN 地塞米松可以延长镇痛持续时间（平均差异[MD]：131.82 分钟，95%置信区间[CI] [38.96，224.68]，I2 = 82%，P = 0.005）、运动阻滞（MD：218.85 分钟，95%CI [113.65，324.05]，I2 = 72%，P < 0.0001）和感觉阻滞（MD：209.57 分钟，95%CI [72.64，346.50]，I2 = 87%，P = 0.003），差异具有统计学意义。在没有肾上腺素的情况下，PN 地塞米松和 IV 地塞米松之间没有显著差异。除了不良反应外，次要结局没有观察到显著差异。PN 地塞米松的不良反应稍高；然而，如果进行敏感性分析，这些结果可能会改变。
纳入的研究存在高度异质性。
与 IV 地塞米松相比，PN 地塞米松可延长镇痛、感觉阻滞和运动阻滞的持续时间。在没有肾上腺素的亚组分析中，2 种给药途径与局部麻醉等效。除不良反应外，次要结局无差异，如果进行敏感性分析，这些结果可能会改变。因此，尽管 PN 地塞米松具有优势，但由于其超适应证性质，需要谨慎使用。尽管本研究结果有希望，但仍需要更多大型和精心设计的 RCT 来验证这些初步发现及其意义。
