锁骨上臂丛神经阻滞下静脉注射地塞米松对腕部和手部手术后疼痛反弹的影响：一项随机安慰剂对照试验。
The effect of intravenous dexamethasone on rebound pain after wrist and hand surgery under supraclavicular brachial plexus blockade: a randomized placebo-controlled trial.
作者信息
Kang RyungA, Bang Yu Jeong, Shim Jae Woo, Choi Soo Joo, Kong So Myung, Hahm Tae Soo, Park Jungchan, Sim Woo Seog, Ko Justin Sangwook
机构信息
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Can J Anaesth. 2025 Jun 20. doi: 10.1007/s12630-025-02992-6.
PURPOSE
We sought to evaluate the efficacy of intravenous dexamethasone in reducing rebound pain post-orthopedic wrist and hand surgery, administered prior to supraclavicular brachial plexus blockade.
METHODS
We conducted a randomized placebo-controlled trial on 56 patients scheduled for elective wrist and hand surgery under supraclavicular brachial plexus blockade. We randomized participants into either a control group, receiving 0.9% of intravenous saline, or a dexamethasone group, receiving 0.11 mg·kg of intravenous dexamethasone. The primary outcome was the difference in pain scores before vs after block resolution. Secondary outcomes included the incidence of rebound pain, pain scores, cumulative opioid consumption, patient satisfaction with postoperative analgesia, and block-related complications in the first 24 hr postoperatively.
RESULTS
The mean (standard deviation [SD]) pain score difference was significantly larger in the control group (7.3 [1.9]) compared with the dexamethasone group (4.7 [2.1]), with a mean difference between groups of 2.6 (95% confidence interval, 1.5 to 3.7; P < 0.001). The incidence of rebound pain was also significantly higher in the control group (79% vs 32%; P < 0.001). The cumulative opioid consumption in 24 hr was greater in the control group than in the dexamethasone group (median [interquartile range (IQR)], 72 [54-97] mg vs 25 [14-60] mg; P < 0.001). We found no significant differences in postoperative complications.
CONCLUSIONS
Preoperative administration of 0.11 mg·kg intravenous dexamethasone significantly reduced rebound pain within 24 hr after wrist and hand surgery under supraclavicular brachial plexus blockade. The results of our trial support the use of intravenous dexamethasone as an effective method for managing postoperative pain for wrist and hand surgery under supraclavicular brachial plexus blockade.
STUDY REGISTRATION
www.CRIS.nih.go.kr ( KCT0007208 ); first submitted 5 April 2022.
目的
我们旨在评估在锁骨上臂丛神经阻滞前静脉注射地塞米松对减轻骨科手腕和手部手术后反跳痛的疗效。
方法
我们对56例计划在锁骨上臂丛神经阻滞下进行择期手腕和手部手术的患者进行了一项随机安慰剂对照试验。我们将参与者随机分为对照组，接受0.9%的静脉生理盐水，或地塞米松组，接受0.11mg·kg的静脉地塞米松。主要结局是神经阻滞消退前后疼痛评分的差异。次要结局包括反跳痛的发生率、疼痛评分、累积阿片类药物消耗量、患者对术后镇痛的满意度以及术后24小时内与神经阻滞相关的并发症。
结果
与地塞米松组（4.7[2.1]）相比，对照组（7.3[1.9]）的平均（标准差[SD]）疼痛评分差异显著更大，组间平均差异为2.6（95%置信区间，1.5至3.7；P < 0.001）。对照组的反跳痛发生率也显著更高（79%对32%；P < 0.001）。对照组24小时内的累积阿片类药物消耗量高于地塞米松组（中位数[四分位间距（IQR）]，72[54 - 97]mg对25[14 - 60]mg；P < 0.001）。我们发现术后并发症无显著差异。
结论
术前静脉注射0.11mg·kg地塞米松可显著减轻锁骨上臂丛神经阻滞下手腕和手部手术后24小时内的反跳痛。我们的试验结果支持将静脉注射地塞米松作为锁骨上臂丛神经阻滞下手腕和手部手术术后疼痛管理的有效方法。
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