直接与外周辅助使用地塞米松对门诊桡骨远端骨折内固定区域麻醉的持续时间和疼痛反弹的疗效：一项前瞻性随机对照双盲研究。
Efficacy of Direct Versus Peripheral Adjuvant Dexamethasone on Duration and Rebound Pain in Regional Anesthesia for Outpatient Distal Radius Fracture Fixation: A Prospective Randomized Controlled Blinded Study.
作者信息
Kasper Alexis A, Plusch Kyle, Voskerijian Armen, Barnabei David, Rivlin Michael, Beredjiklian Pedro K, Wang Mark L
机构信息
Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Thomas Jefferson University, Philadelphia, PA, USA.
出版信息
Hand (N Y). 2024 Sep 11:15589447241270678. doi: 10.1177/15589447241270678.
BACKGROUND
Despite increasingly wider use, there remains controversy among anesthesiologists regarding preferred formulations and the role of steroid adjuvants in regional anesthesia. There is also uncertainty in the role of dexamethasone when administered directly versus peripherally. We hypothesize that directly mixing dexamethasone into the regional nerve block rather than peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy concerning duration and rebound pain, decreased postoperative pain scores, or opioid consumption within the short-term postoperative period.
METHODS
A prospective, randomized controlled blinded study was conducted for patients undergoing open reduction and internal fixation with a volar plate technique for distal radius fractures. Patients were randomized for their preoperative anesthesia. One group had ultrasound-guided supraclavicular block with ropivacaine with a direct mix of dexamethasone 4 mg (Direct group), while the other group had ultrasound-guided supraclavicular block with ropivacaine and peripheral intravenous dexamethasone 4 mg (Indirect group). Data was collected pre, intra, and postoperatively.
RESULTS
Fifty patients consented and participated in the study, with 27 participants in the direct group and 23 participants in the indirect group. Compared to intravenous administration, directly administered dexamethasone demonstrated a significant difference in the average time for the block to fade, onset of motor and sensory recovery, and block resolution.
CONCLUSION
Our findings prove that directly mixing dexamethasone compared to peripherally administered intravenous dexamethasone will demonstrate a difference in efficacy with regards to duration and rebound pain, but do not prove that there will be a difference in decreased postoperative pain scores or opioid consumption within the 24-hour postoperative period.
LEVEL OF EVIDENCE
Prognosis Level I.
背景
尽管使用越来越广泛，但麻醉医生对于区域麻醉中首选配方以及类固醇佐剂的作用仍存在争议。地塞米松直接给药与外周给药的作用也存在不确定性。我们假设，将地塞米松直接混入区域神经阻滞中，而非外周静脉注射地塞米松，在短期术后期间，在阻滞持续时间和疼痛反弹、降低术后疼痛评分或阿片类药物消耗方面，疗效会有所不同。
方法
对采用掌侧钢板技术进行桡骨远端骨折切开复位内固定术的患者进行了一项前瞻性、随机对照双盲研究。患者术前随机接受麻醉。一组接受超声引导下锁骨上阻滞，使用罗哌卡因并直接混合4毫克地塞米松（直接组），而另一组接受超声引导下锁骨上阻滞，使用罗哌卡因并外周静脉注射4毫克地塞米松（间接组）。在术前、术中和术后收集数据。
结果
50名患者同意并参与了研究，直接组有27名参与者，间接组有23名参与者。与静脉给药相比，直接给药的地塞米松在阻滞消退的平均时间、运动和感觉恢复的开始以及阻滞消退方面表现出显著差异。
结论
我们的研究结果证明，与外周静脉注射地塞米松相比，直接混合地塞米松在阻滞持续时间和疼痛反弹方面疗效会有所不同，但并未证明在术后24小时内降低术后疼痛评分或阿片类药物消耗方面会有差异。
证据水平
预后I级。
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