Department of Anesthesiology and Acute Postoperative & Transitional Pain Service, Cliniques Universitaires St Luc-University Catholic of Louvain, Brussels, Belgium.
Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
Br J Anaesth. 2023 Jul;131(1):8-10. doi: 10.1016/j.bja.2023.04.013. Epub 2023 May 12.
Intraoperative use of glucocorticoids is effective for postoperative nausea and vomiting prophylaxis and can also provide early postoperative analgesic effects, but the consequences for chronic post-surgical pain are debatable. In a secondary analysis of the large pragmatic Perioperative Administration of Dexamethasone and Infection trial (n=8478), the primary outcome of pain at the surgical wound at 6 months after surgery was increased in subjects receiving dexamethasone 8 mg i.v. for postoperative nausea and vomiting prophylaxis, a dose not associated with the detrimental effect of surgical site infection in the original study. In contrast, a more detailed assessment of chronic post-surgical pain after exclusion of patients with preoperative pain at the surgical site showed no differences with or without intraoperative dexamethasone regarding chronic post-surgical pain characteristics (intensity and neuropathic features). Because of several confounding factors especially regarding surgical details, these unexpected findings call for more well-designed studies about the potential risk of intraoperative treatments, such as glucocorticoids, on late post-surgical pain.
术中使用糖皮质激素可有效预防术后恶心和呕吐，并可提供早期术后镇痛效果，但对慢性术后疼痛的后果存在争议。在一项关于围手术期使用地塞米松和感染的大型实用研究（n=8478）的二次分析中，接受地塞米松 8 毫克静脉注射预防术后恶心和呕吐的患者，其术后 6 个月手术伤口疼痛的主要结局增加，这一剂量与原始研究中手术部位感染的有害作用无关。相比之下，在排除术前手术部位疼痛的患者后，对慢性术后疼痛进行更详细的评估显示，术中使用地塞米松与否在慢性术后疼痛特征（强度和神经病理性特征）方面没有差异。由于存在几个混杂因素，特别是关于手术细节的因素，这些意外的发现呼吁进行更多设计良好的研究，以了解术中治疗（如糖皮质激素）对晚期术后疼痛的潜在风险。
