Mitchell C, Cheuk S J, O'Donnell C M, Bampoe S, Walker D
Department of Anaesthesia, Ulster Hospital, Dundonald, Belfast, Northern Ireland.
Department of Anaesthesia, Royal Belfast Hospital for Sick Children, Royal Group of Hospitals, Belfast, Northern Ireland.
Perioper Med (Lond). 2022 Mar 24;11(1):13. doi: 10.1186/s13741-022-00243-6.
Previous meta-analysis of heterogeneous surgical cohorts demonstrated reduction in postoperative pain with perioperative intravenous dexamethasone, but none have addressed adults undergoing elective abdominal surgery. The aim of this study was to determine the impact of intravenous perioperative dexamethasone on postoperative pain in adults undergoing elective abdominal surgery under general anaesthesia.
This review was prospectively registered on the international prospective register of systematic reviews (CRD42020176202). Electronic databases Medical Analysis and Retrieval System Online (MEDLINE), Exerpta Medica Database (EMBASE), (CINAHL) Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and trial registries were searched to January 28 2021 for randomised controlled trials, comparing dexamethasone to placebo or alternative antiemetic, that reported pain. The primary outcome was pain score, and secondary outcomes were time to first analgesia, opioid requirements and time to post-anaesthesia care unit (PACU) discharge.
Fifty-two studies (5768 participants) were included in the meta-analysis. Pain scores ≤ 4 hour (h) were reduced in patients who received dexamethasone at rest (mean difference (MD), - 0.54, 95% confidence interval (CI) - 0.72 to - 0.35, I = 81%) and on movement (MD - 0.42, 95% CI - 0.62 to - 0.22, I = 35). In the dexamethasone group, 4-24 h pain scores were less at rest (MD - 0.31, 95% CI - 0.47 to - 0.14, I = 96) and on movement (MD - 0.26, 95% CI - 0.39 to - 0.13, I = 29) and pain scores ≥ 24 h were reduced at rest (MD - 0.38, 95% CI - 0.52 to - 0.24, I = 88) and on movement (MD - 0.38, 95% CI - 0.65 to - 0.11, I = 71). Time to first analgesia (minutes) was increased (MD 22.92, 95% CI 11.09 to 34.75, I = 98), opioid requirements (mg oral morphine) decreased (MD - 6.66, 95% CI - 9.38 to - 3.93, I = 88) and no difference in time to PACU discharge (MD - 3.82, 95% CI - 10.87 to 3.23, I = 59%).
Patients receiving dexamethasone had reduced pain scores, postoperative opioid requirements and longer time to first analgesia. Dexamethasone is an effective analgesic adjunct for patients undergoing abdominal surgery.
先前对异质性手术队列的荟萃分析表明，围手术期静脉注射地塞米松可减轻术后疼痛，但均未涉及接受择期腹部手术的成年人。本研究的目的是确定围手术期静脉注射地塞米松对接受全身麻醉的择期腹部手术成年患者术后疼痛的影响。
本综述已在国际前瞻性系统评价注册库（CRD42020176202）上进行前瞻性注册。检索了电子数据库医学分析和在线检索系统（MEDLINE）、医学文摘数据库（EMBASE）、护理及相关健康文献累积索引（CINAHL）、Cochrane对照试验中心注册库（CENTRAL）、科学网和试验注册库，截至2021年1月28日，查找比较地塞米松与安慰剂或其他止吐药并报告疼痛情况的随机对照试验。主要结局是疼痛评分，次要结局是首次镇痛时间、阿片类药物需求量和麻醉后护理单元（PACU）出院时间。
荟萃分析纳入了52项研究（5768名参与者）。接受地塞米松治疗的患者静息时≤4小时（h）的疼痛评分降低（平均差（MD），-0.54，95%置信区间（CI）-0.72至-0.35，I² = 81%），活动时疼痛评分也降低（MD -0.42，95%CI -0.62至-0.22，I² = 35）。在地塞米松组中，4 - 24小时静息时疼痛评分更低（MD -0.31，95%CI -0.47至-0.14，I² = 96），活动时疼痛评分也更低（MD -0.26，95%CI -0.39至-0.13，I² = 29），≥24小时静息时疼痛评分降低（MD -0.38，95%CI -0.52至-0.24，I² = 88），活动时疼痛评分降低（MD -0.38，95%CI -0.65至-0.11，I² = 71）。首次镇痛时间（分钟）延长（MD 22.92，95%CI 11.09至34.75，I² = 98），阿片类药物需求量（口服吗啡毫克数）减少（MD -6.66，95%CI -9.38至-3.93，I² = 88），PACU出院时间无差异（MD -3.82，95%CI -10.87至3.23，I² = 59%）。
接受地塞米松治疗的患者疼痛评分降低，术后阿片类药物需求量减少，首次镇痛时间延长。地塞米松是腹部手术患者有效的镇痛辅助药物。
