Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.
Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea.
J Korean Med Sci. 2023 Jun 19;38(24):e183. doi: 10.3346/jkms.2023.38.e183.
Interscalene brachial plexus block (ISB) is a common regional technique to manage acute postoperative pain for arthroscopic rotator cuff tear repair. However, rebound pain may compromise its overall benefit. Our aim was to investigate the primary hypothesis that perineural and intravenous dexamethasone have different effects on rebound pain after resolution of ISB for arthroscopic rotator cuff tear repair.
Patients aged ≥ 20 years scheduled for elective arthroscopic rotator cuff tear repair under general anesthesia with preoperative ISB were included. The participants were randomized to receive dexamethasone either perineurally (perineural group) or intravenously (intravenous group). In the perineural group, patients received ISB with 12 mL of 0.5% ropivacaine containing 5 mg of dexamethasone; simultaneously, 1 mL of 0.9% normal saline was administered intravenously. In the intravenous group, patients received ISB with 12 mL of 0.5% ropivacaine; simultaneously, 1 mL of dexamethasone 5 mg was administered intravenously. The primary outcome was the difference in the pain score (0-10 on numeric rating scale) between before and after ISB resolution. The secondary outcomes were the incidence of rebound pain; onset, duration, and intensity of rebound pain; time to the first analgesic request; and pain-related sleep disturbance.
A total of 71 patients were randomized to either perineural group (n = 36) or intravenous group (n = 35). After block resolution, pain scores increased significantly more in the perineural group (mean ± standard deviation, 4.9 ± 2.1) compared to the intravenous group (4.0 ± 1.7, = 0.043). The duration of ISB was more prolonged in the perineural group (median [interquartile range], 19.9 [17.2-23.1] hours) than the intravenous group (15.1 [13.7-15.9] hours, < 0.001). The incidence of rebound pain and pain-related sleep disturbance during the first postoperative week was significantly higher in the perineural group than in the intravenous group (rebound pain: 44.4% vs. 20.0%, = 0.028; sleep disturbance: 55.6% vs. 25.7%, = 0.011). The duration and intensity of rebound pain were similar between the two groups.
Although perineural dexamethasone provided longer postoperative analgesia, intravenous dexamethasone was more beneficial in reducing pain increase after ISB resolution, incidence of rebound pain, and pain-related sleep disturbance.
Clinical Research Information Service Identifier: KCT0006795.
经肌间沟臂丛神经阻滞（ISB）是一种常用于管理关节镜肩袖撕裂修复术后急性疼痛的区域技术。然而，反弹疼痛可能会影响其整体效果。我们的目的是调查主要假设，即神经周围和静脉内地塞米松对关节镜肩袖撕裂修复术后 ISB 缓解后反弹疼痛有不同的影响。
纳入年龄≥ 20 岁、接受全身麻醉下择期关节镜肩袖撕裂修复术且术前行 ISB 的患者。参与者被随机分为接受神经周围地塞米松（神经周围组）或静脉内地塞米松（静脉内组）。在神经周围组中，患者接受含 5 毫克地塞米松的 0.5%罗哌卡因 12 毫升的 ISB；同时静脉内给予 1 毫升 0.9%生理盐水。在静脉内组中，患者接受含 5 毫克地塞米松的 0.5%罗哌卡因 12 毫升的 ISB；同时静脉内给予 1 毫升地塞米松。主要结局是 ISB 缓解前后疼痛评分（0-10 数字评分量表）的差异。次要结局是反弹疼痛的发生率；反弹疼痛的发作、持续时间和强度；首次镇痛请求的时间；以及与疼痛相关的睡眠障碍。
共有 71 名患者被随机分配至神经周围组（n = 36）或静脉内组（n = 35）。与静脉内组（4.0 ± 1.7， = 0.043）相比，神经周围组（4.9 ± 2.1）ISB 缓解后疼痛评分显著增加。神经周围组 ISB 持续时间（中位数[四分位间距]，19.9 [17.2-23.1] 小时）明显长于静脉内组（15.1 [13.7-15.9] 小时， < 0.001）。神经周围组在术后第一周反弹疼痛和与疼痛相关的睡眠障碍发生率明显高于静脉内组（反弹疼痛：44.4% vs. 20.0%， = 0.028；睡眠障碍：55.6% vs. 25.7%， = 0.011）。两组间反弹疼痛的持续时间和强度相似。
虽然神经周围地塞米松提供了更长时间的术后镇痛，但静脉内地塞米松在减少 ISB 缓解后疼痛增加、反弹疼痛发生率和与疼痛相关的睡眠障碍方面更有益。
临床研究信息服务标识符：KCT0006795。
