胸腔镜手术竖脊肌平面阻滞和前锯肌平面阻滞联合静脉注射地塞米松与右美托咪定对术后疼痛控制的改善：一项随机对照试验
Improvement in postoperative pain control by combined use of intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block for thoracoscopic surgery: a randomized controlled trial.
作者信息
Zhang Li, Xu Zhibiao, Liu Yuyun, Ling Zijie, Yuan Sumin, Meng Yuxiang, Li Ziwei, Feng Shoujie, Liu Su, Zhao Linlin
机构信息
Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai Road, Quanshan District, Xuzhou City, 221002, China.
出版信息
BMC Anesthesiol. 2025 Apr 10;25(1):171. doi: 10.1186/s12871-025-03039-5.
BACKGROUND
Acute pain after thoracoscopic surgery is very noticeable and often requires additional techniques or adjunctive medications to reduce it. We investigated whether intravenous dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block could further decrease the incidence of moderate-to-severe pain.
METHODS
A total of 81 patients were randomly assigned to group C (20 mL normal saline), group S (10 mg dexamethasone + normal saline to 20 mL), or group SM (10 mg dexamethasone + 1 µg/kg dexmedetomidine + normal saline to 20 mL). All patients underwent erector spinae plane block and serratus anterior plane block 30 min before anesthesia induction and all drugs were infused intravenously 30 min after general anesthesia induction. The primary outcome was incidence of moderate-to-severe pain at 24 h on movement postoperatively. Secondary outcomes included incidence of moderate-to-severe pain on movement and at rest throughout the first two postoperative days, pain score, opioid consumption, quality of recovery and adverse effects.
RESULTS
Group SM lowered the incidence of moderate-to-severe pain on movement at 24 h postoperatively than group C (11.1% vs. 48.0%; RR 0.231; 95% CI, 0.074 to 0.725) and group S (11.1% vs. 38.5%; RR 0.289; 95% CI, 0.089 to 0.933). Group SM reduced NRS score on movement (3.0 [3.0] vs. 3.0 [2.0] vs. 3.0[1.0]; P < 0.001) and total opioid consumption (26.0 [6.0] vs. 32.0 [9.0] vs. 28.0 [2.5]; P = 0.004) within 24 h after surgery, fewer patients required rescue analgesia (11.1% vs. 48.0% vs. 38.5%; P = 0.009). Group SM also lowered incidence of nausea and vomiting (7.4% vs. 32.0% vs. 30.8%; P = 0.047) and had a higher QoR-15 score at postoperative 24 h (132.0 [10.0] vs. 123.0 [8.0] vs. 127.5 [10.8]; P < 0.001).
CONCLUSIONS
Intravenous administration of dexamethasone with dexmedetomidine after erector spinae plane block and serratus anterior plane block further decreased the incidence of moderate-to-severe pain. It also reduced NRS scores and opioid consumption, making the postoperative pain control better for thoracoscopic surgery.
TRIAL REGISTRATION
The study was registered at Chictr.org.cn with the number ChiCTR2400084435 on 05/16/2024.
背景
胸腔镜手术后的急性疼痛非常明显，通常需要额外的技术或辅助药物来减轻。我们研究了在竖脊肌平面阻滞和前锯肌平面阻滞之后静脉注射地塞米松与右美托咪定是否能进一步降低中重度疼痛的发生率。
方法
总共81例患者被随机分配至C组（20毫升生理盐水）、S组（10毫克地塞米松+生理盐水至20毫升）或SM组（10毫克地塞米松+1微克/千克右美托咪定+生理盐水至20毫升）。所有患者在麻醉诱导前30分钟接受竖脊肌平面阻滞和前锯肌平面阻滞，所有药物在全身麻醉诱导后30分钟静脉输注。主要结局是术后24小时活动时中重度疼痛的发生率。次要结局包括术后前两天活动和静息时中重度疼痛的发生率、疼痛评分、阿片类药物消耗量、恢复质量和不良反应。
结果
SM组术后24小时活动时中重度疼痛的发生率低于C组（11.1% 对48.0%；相对危险度0.231；95%置信区间，0.074至0.725）和S组（11.1% 对38.5%；相对危险度0.289；95%置信区间，0.089至0.933）。SM组术后24小时内活动时的数字评分法（NRS）评分降低（3.0[3.0]对3.0[2.0]对3.0[1.0]；P<0.001），总阿片类药物消耗量减少（26.0[6.0]对32.0[9.0]对28.0[2.5]；P=0.004），需要补救镇痛的患者更少（11.1% 对48.0% 对38.5%；P=0.009）。SM组还降低了恶心和呕吐的发生率（7.4% 对32.0% 对30.8%；P=0.047），术后24小时的快速恢复质量-15（QoR-15）评分更高（132.0[10.0]对123.0[8.0]对127.5[10.8]；P<0.001）。
结论
在竖脊肌平面阻滞和前锯肌平面阻滞之后静脉注射地塞米松与右美托咪定可进一步降低中重度疼痛的发生率。它还降低了NRS评分和阿片类药物消耗量，使胸腔镜手术的术后疼痛控制更佳。
试验注册
该研究于2024年5月16日在中国临床试验注册中心（Chictr.org.cn）注册，注册号为ChiCTR2400084435。
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