超声引导下锁骨下阻滞时神经周围注射地塞米松与神经周围联合注射地塞米松-右美托咪定的随机对照研究
Randomized comparison between perineural dexamethasone and combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block.
作者信息
Aliste Julián, Layera Sebastián, Bravo Daniela, Aguilera Germán, Erpel Hans, García Armando, Lizama Marcelo, Finlayson Roderick J, Tran D
机构信息
Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile.
Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago de Chile, Chile
出版信息
Reg Anesth Pain Med. 2022 Jun 21. doi: 10.1136/rapm-2022-103760.
BACKGROUND
This randomized trial compared perineural dexamethasone with combined perineural dexamethasone-dexmedetomidine for ultrasound-guided infraclavicular block. We hypothesized that the combination of perineural adjuvants would result in a longer motor block.
METHODS
Fifty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block (using 35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) were randomly allocated to receive perineural dexamethasone (2 mg) or combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg). After the performance of the block, a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), the onset time (defined as the time required to reach a minimal composite score of 14 points) as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids or general anesthesia).Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block and postoperative analgesia.
RESULTS
No intergroup differences were observed in terms of success rate, onset time and surgical anesthesia. Compared with dexamethasone alone, combined dexamethasone-dexmedetomidine provided longer durations of motor block (21.5 (2.7) vs 17.0 (3.9) hours; p<0.001; 95% CI 2.6 to 6.4), sensory block (21.6 (3.6) vs 17.2 (3.6) hours; p<0.001; 95% CI 2.2 to 6.5), and postoperative analgesia (25.5 (9.4) vs 23.5 (5.6) hours; p=0.038; 95% CI 1.0 to 7.7).
CONCLUSION
Compared with perineural dexamethasone (2 mg) alone, combined perineural dexamethasone (2 mg)-dexmedetomidine (50 µg) results in longer durations of sensorimotor block and analgesia. Further studies are required to determine the optimal dosing combination for dexamethasone-dexmedetomidine.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov identifier: NCT04875039.
背景
本随机试验比较了神经周围注射地塞米松与神经周围联合注射地塞米松-右美托咪定用于超声引导下锁骨下阻滞的效果。我们假设神经周围辅助药物联合使用会导致运动阻滞时间延长。
方法
50例接受上肢手术并采用超声引导下锁骨下阻滞（使用35 mL 1%利多卡因-0.25%布比卡因加5 μg/mL肾上腺素）的患者被随机分配接受神经周围注射地塞米松（2 mg）或神经周围联合注射地塞米松（2 mg）-右美托咪定（50 μg）。在完成阻滞后，由一名不知情的观察者评估成功率（定义为30分钟时最小感觉运动综合评分为16分中的14分）、起效时间（定义为达到最小综合评分为14分所需的时间）以及手术麻醉发生率（定义为无需局部浸润、补充阻滞、静脉注射阿片类药物或全身麻醉即可完成手术的能力）。术后，不知情的观察者联系阻滞成功的患者，询问运动阻滞、感觉阻滞和术后镇痛的持续时间。
结果
在成功率、起效时间和手术麻醉方面未观察到组间差异。与单独使用地塞米松相比，地塞米松-右美托咪定联合使用导致运动阻滞持续时间更长（21.5（2.7）小时对17.0（3.9）小时；p<0.001；95%可信区间2.6至6.4）、感觉阻滞持续时间更长（21.6（3.6）小时对17.2（3.6）小时；p<0.001；95%可信区间2.2至6.5）以及术后镇痛持续时间更长（25.5（9.4）小时对23.5（5.6）小时；p=0.038；95%可信区间1.0至7.7）。
结论
与单独使用神经周围注射地塞米松（2 mg）相比，神经周围联合注射地塞米松（2 mg）-右美托咪定（50 μg）导致感觉运动阻滞和镇痛的持续时间更长。需要进一步研究以确定地塞米松-右美托咪定的最佳给药组合。
试验注册号
ClinicalTrials.gov标识符：NCT04875039。
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