Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Department of Anaesthesiology, Research Centre of Anaesthesiology and Intensive Care Medicine, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
Acta Anaesthesiol Scand. 2022 Oct;66(9):1070-1076. doi: 10.1111/aas.14118. Epub 2022 Aug 4.
The effects of glucocorticoids may include both genomic and rapid nongenomic effects. The potential rapid analgesic effect during surgery has not previously been investigated. We aimed to explore the effect of dexamethasone on intraoperative infusion rate of remifentanil in patients undergoing total knee arthroplasty (TKA) surgery under general anaesthesia.
In this post hoc subgroup analysis, we included patients randomised in the DEX-2-TKA trial, who were operated under total intravenous anaesthesia with remifentanil and propofol. Trial medication, intravenous dexamethasone 24 mg or placebo, was administered immediately after anaesthesia onset. The primary outcome was the median weight-corrected infusion rate of remifentanil during surgery. Secondary outcomes included median weight-corrected infusion rate of propofol, median intraoperative bispectral index and time spent in the post-anaesthesia care unit.
Eighty-seven patients were included in the analysis of the primary outcome. A significantly higher remifentanil infusion rate was observed in the dexamethasone group compared with the placebo group, p = .02. None of the secondary outcomes resulted in statistically significant differences between groups.
This explorative post hoc analysis of the randomised DEX-2-TKA trail showed that patients undergoing TKA surgery under general anaesthesia and who received dexamethasone seemed to have a higher remifentanil infusion rate compared with patients who received placebo. The clinical implications of the potentially increased remifentanil infusion rate need to be validated and explored further.
ClinicalTrials.gov Identifier: NCT05002361 (12 August 2021).
糖皮质激素的作用可能包括基因组和快速非基因组作用。其在手术期间的潜在快速镇痛作用尚未得到研究。我们旨在探讨在全身麻醉下接受全膝关节置换术（TKA）的患者中，地塞米松对术中瑞芬太尼输注率的影响。
在这项事后亚组分析中，我们纳入了在 DEX-2-TKA 试验中随机分组的患者，这些患者在全身麻醉下接受瑞芬太尼和丙泊酚的全静脉麻醉。试验药物，即静脉注射地塞米松 24mg 或安慰剂，在麻醉开始后立即给予。主要结局是手术期间校正体重的瑞芬太尼的中位数输注率。次要结局包括校正体重的丙泊酚中位数输注率、术中中位数双谱指数和麻醉后护理单元停留时间。
87 例患者纳入主要结局分析。与安慰剂组相比，地塞米松组的瑞芬太尼输注率显著更高，p=0.02。组间无其他次要结局存在统计学差异。
这项对随机 DEX-2-TKA 试验的探索性事后分析表明，在全身麻醉下接受 TKA 手术并接受地塞米松治疗的患者，与接受安慰剂治疗的患者相比，似乎具有更高的瑞芬太尼输注率。需要进一步验证和探讨潜在增加的瑞芬太尼输注率的临床意义。
ClinicalTrials.gov 标识符：NCT05002361（2021 年 8 月 12 日）。
