Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Anesthesiology and Critical Care Research Center (ACCRC), Isfahan University of Medical Sciences, Isfahan, Iran.
BMC Anesthesiol. 2024 Jul 16;24(1):240. doi: 10.1186/s12871-024-02625-3.
Thoracotomy procedures can result in significant pain and cause nausea/vomiting. Glucocorticoids have anti-emetic and analgesic effects due to their anti-inflammatory and nerve-blocking properties. This study investigates the additive effect of local dexamethasone with bupivacaine as sole analgesic medication through a peripleural catheter after thoracotomy.
The study was conducted as a randomized control trial on 82 patients. Participants were allocated to receive either 2.5 mg/kg of bupivacaine plus 0.2 mg/kg of dexamethasone or 2.5 mg/kg of bupivacaine plus the same amount of normal saline as placebo through a 6 French peripleural catheter implemented above the parietal pleura and beneath the musculoskeletal structure of the chest wall. The primary outcome was the severity of pain 24 h after the operation in the visual analogue scale (VAS) score. Secondary outcomes were the incidence of nausea/vomiting, opioid consumption for pain control, and incidence of any adverse effects.
A total of 50 participants were randomized to each group, and the baseline characteristics were similar between the groups. Median of VAS score (6 (3-8) vs. 8 (6-9), p < 0.001), postoperative opioid consumption (9 (36%) vs. 17 (68%) patients, p=0.024), and median length of hospital stay (4 (3-8) vs. 6 (3-12) days, p < 0.001) were significantly lower in the dexamethasone group. However, postoperative nausea/vomiting (p=0.26 for nausea and p=0.71 for vomiting) and surgical site infection (p = 0.55) were similar between the two groups.
In thoracotomy patients, administering local dexamethasone + bupivacaine through a peripleural catheter can reduce postoperative pain, analgesic consumption, and length of hospital stay.
Iranian Registry of Clinical Trials (IRCT20220309054226N1, registration date: 3/21/2022.
开胸手术后会产生剧烈疼痛，并引起恶心/呕吐。糖皮质激素具有抗炎和神经阻滞作用，因此具有止吐和镇痛作用。本研究通过开胸术后胸膜外导管探究单独使用布比卡因联合局部地塞米松作为镇痛药物的附加效果。
该研究采用随机对照试验，纳入 82 名患者。参与者被分配接受 2.5mg/kg 布比卡因加 0.2mg/kg 地塞米松或 2.5mg/kg 布比卡因加相同量生理盐水作为安慰剂，通过置于壁层胸膜上方和胸壁肌骨骼结构下方的 6 号胸膜外导管给药。主要结局是术后 24 小时视觉模拟评分（VAS）中的疼痛严重程度。次要结局是恶心/呕吐的发生率、用于疼痛控制的阿片类药物消耗以及任何不良反应的发生率。
共有 50 名参与者被随机分配到每组，两组的基线特征相似。地塞米松组的 VAS 评分中位数（6（3-8）比 8（6-9），p<0.001）、术后阿片类药物消耗（9（36%）比 17（68%）患者，p=0.024）和中位住院时间（4（3-8）比 6（3-12）天，p<0.001）显著降低。然而，术后恶心/呕吐（恶心 p=0.26，呕吐 p=0.71）和手术部位感染（p=0.55）在两组之间无差异。
在开胸手术患者中，通过胸膜外导管给予局部地塞米松+布比卡因可以减轻术后疼痛、减少阿片类药物消耗并缩短住院时间。
伊朗临床试验注册中心（IRCT20220309054226N1，注册日期：2022 年 3 月 21 日）。
