Zhu Na, Xiang Bingbing, Shi Jinghong, Yang Pingliang, Dai Yunke, Wang Shun
Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
Heliyon. 2024 Aug 2;10(16):e35612. doi: 10.1016/j.heliyon.2024.e35612. eCollection 2024 Aug 30.
While numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed.
This study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery.
A prospective randomized double-blinded trial.
The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022.
Patients aged 18 - 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery.
Patients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group).
Primary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events.
Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 - 5.72, P < 0.05). No significant differences were observed in postoperative hyperglycemia or surgical site infection rates.
Perineural dexamethasone may impede nerve function recovery, suggesting caution in its use, particularly for patients with pre-existing nerve damage or diabetes. Further research is needed to elucidate the long-term effects of dexamethasone on nerve tissue recovery.
chictr.org.cn, ChiCTR2200059424.
尽管众多研究已探讨了神经周围注射地塞米松对神经阻滞持续时间的影响，但其对术后神经损伤的潜在影响尚未得到充分研究。
本研究旨在阐明神经周围注射地塞米松对术后神经损伤及神经功能恢复的影响。
一项前瞻性随机双盲试验。
中国成都医学院第一附属医院。研究于2022年6月14日至12月30日进行。
年龄在18 - 80岁、美国麻醉医师协会（ASA）分级为I - II级、计划行择期骨科手术或烧伤整形手术的患者。
患者被随机分为接受神经周围注射地塞米松组（D组）或不接受地塞米松组（ND组）。
主要结局为神经损伤的发生率及恢复情况。次要结局包括术后疼痛评分、镇痛药使用量及不良事件。
术后初期两组神经损伤发生率相似（D组：30.4%，ND组：33.3%，P > 0.05）。出院后12周时，ND组神经功能缺损恢复的患者显著多于D组（78.8%对60.3%；比值比[OR]=2.45，95%置信区间[CI]=1.05 - 5.72，P < 0.05）。术后高血糖或手术部位感染率无显著差异。
神经周围注射地塞米松可能会阻碍神经功能恢复，提示使用时需谨慎，尤其是对于已有神经损伤或糖尿病患者。需要进一步研究以阐明地塞米松对神经组织恢复的长期影响。
中国临床试验注册中心，注册号：ChiCTR2200059424。
