Department of Anesthesia and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Br J Anaesth. 2024 May;132(5):1112-1121. doi: 10.1016/j.bja.2023.09.022. Epub 2023 Oct 26.
Rebound pain occurs after the resolution of peripheral nerve block and hampers patient recovery in the postoperative period. We sought to synthesise available data from randomised controlled trials (RCTs) evaluating the efficacy of prophylactic dexamethasone for rebound pain in adult patients undergoing surgery with a peripheral nerve block.
In this systematic review and meta-analysis, RCTs reporting rebound pain and use of dexamethasone in the context of a peripheral nerve block were searched in various databases and updated in May 2023. The primary outcome was the incidence of rebound pain; secondary outcomes included the severity and time to onset of rebound pain, patient satisfaction with pain control, sleep disturbance because of pain, and adverse effects of dexamethasone. Subgroup analysis was conducted based on the effect of route of administration (intravenous or perineural) on the incidence of rebound pain. Trial sequential analysis was performed to rule out the possibility of a false positive result.
Seven RCTs comprising 574 patients were included in this review. The dexamethasone group was associated with a reduction in the incidence of rebound pain with an odds ratio of 0.16 (95% confidence interval 0.10-0.27, P=0.00, I=0%) compared with the control group. Trial sequential analysis confirmed the adequate information size for the beneficial effect of dexamethasone. Subgroup analysis showed that both intravenous and perineural administration were associated with a significant reduction in the incidence of rebound pain.
Current evidence suggests that both intravenous and perineural dexamethasone reduce the incidence of rebound pain after a peripheral nerve block provided for postoperative analgesia.
PROSPERO CRD42023424031.
外周神经阻滞解除后会出现反弹痛，这会妨碍患者在术后的恢复。我们旨在综合评估预防性使用地塞米松预防成人外周神经阻滞术后反弹痛的随机对照试验（RCT）的现有数据。
在本次系统评价和荟萃分析中，我们在多个数据库中检索了报告反弹痛和在外周神经阻滞中使用地塞米松的 RCT，并于 2023 年 5 月进行了更新。主要结局是反弹痛的发生率；次要结局包括反弹痛的严重程度和发病时间、患者对疼痛控制的满意度、因疼痛导致的睡眠障碍以及地塞米松的不良反应。根据给药途径（静脉内或神经周围）对反弹痛发生率的影响进行亚组分析。进行试验序贯分析以排除假阳性结果的可能性。
本综述纳入了 7 项 RCT，共 574 例患者。与对照组相比，地塞米松组的反弹痛发生率降低，优势比为 0.16（95%置信区间 0.10-0.27，P=0.00，I=0%）。试验序贯分析证实了地塞米松有益效果的充分信息大小。亚组分析显示，静脉内和神经周围给药均与反弹痛发生率的显著降低相关。
目前的证据表明，静脉内和神经周围给予地塞米松均可降低外周神经阻滞用于术后镇痛后反弹痛的发生率。
PROSPERO CRD42023424031。
