A randomised controlled trial of intravenous Dexamethasone combined with interscalene brachial plexus blockade guided by ultrasound in shoulder surgery
LIN Lei1 CHEN Chun1 HOU Jun2 YANG Ping2
1.Department of Anesthesia, the First College of Clinical Medical Science, Three Gorges University, Hubei Province, Yichang 443003, China;
2.Department of Anesthesia, Yichang Central People's Hospital, Hubei Province, Yichang 443003, China
Abstract：Objective To investigate the effects of intravenous injection of different doses of Dexamethasone combined with ultrasound-guided interscalene bronchial plexus block on postoperative analgesia in patients underwent shoulder surgery. Methods 80 cases of patients underwent shoulder arthroscopy under interscalene brachial plexus blockade in Yichang Central People's Hospital from June 2014 to October 2015 were chosen and randomly divided into four groups: intravenous injection of saline (group A, n=20), 0.025 mg/kg Dexamethasone (group B, n=20), 0.05 mg/kg Dexamethasone (group C, n=20), 0.1 mg/kg Dexamethasone (group D, n=20) before blockade, respectively. Outcomes for 48 h were recorded. Primary endpoint was the time to first postoperative analgesic required. No or mild pain at 24 h and 48 h, weakness at 24 h, cumulative analgesic consumption, sleep disturbance, nausea and vomiting, and satisfaction were considered as secondary outcomes. Results The median time to first postoperative analgesic required was significantly longer in group C and group D than that in group A (P < 0.01), but there was no significant difference between group C and group D (P > 0.05). Among the four groups, no or mild pain at 24 h and 48 h, weakness at 24 h, no analgesia required, the amount of Tramadol and Dolantin required were compared, there were no significant differences (P > 0.05), but the amount of Diclofenac Sodium Suppository was lower in group D than that in group A (P < 0.05). The incidence of sleep disturbance in group C and group D was less than that in group A (P < 0.05), and patients' anesthesia satisfaction rate in group D was higher than that in group A (P < 0.05). Conclusion Intravenous injection of 0.05 mg/kg or 0.1 mg/kg Dexamethasone can extend the duration of postoperative analgesia provided by interscalene brachial plexus block, patients' satisfaction with anesthesia by using 0.1 mg/kg Dexamethasone is higher.
[1] Choi S，Rodseth R，McCartney CJ. Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block：a systematic review and meta-analysis of randomized trials [J]. Br J Anaesth，2014，112（3）：427-439.
[2] Albrecht E，Kern C，Kirkham KR. A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks [J]. Anaesthesia，2015，70（1）：71-83.
[3] De Oliveira GS Jr，Castro Alves LJ，Nader A，et al. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks：a metaanalysis of randomized controlled trials [J]. Pain Res Treat，2014，2014：179029.
[4] 康志宇，王庚，朱丰，等.不同剂量地塞米松用于超声引导神经刺激器定位肌间沟臂丛神经阻滞效果的观察[J].中国医药导报，2015，12（5）：81-85.
[5] 张大志，王怀江，刘永盛，等.不同剂量地塞米松对罗哌卡因神经阻滞作用的影响[J].临床麻醉学杂志，2013，3（29）：213-215.
[6] Parrington SJ，O'Donnell D，Chan VW，et al. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade [J]. Reg Anesth Pain Med，2010，35（5）：422–426.
[7] Cummings KC，Napierkowski DE，Parra-Sanchez I，et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine [J]. Br J Anaesth，2011，107（3）：446-453.
[8] Yilmaz-Rastoder E，Gold MS，Hough KA，et al. Effect of adjuvant drugs on the action of local anesthetics in isolated rat sciatic nerves [J]. Reg Anesth Pain Med，2012，37（4）：403-409.
[9] Noss CD，Mackenzie LD，Kostash MA. Adjuvant dexamethasone：innovation，farce，or folly? [J]. Reg Anesth Pain Med，2014，39（6）：540-545.
[10] Candido KD，Knezevic NN. All adjuvants to local anesthetics were not created equal：animal data evaluating neurotoxicity，thermal hyperalgesia，and relevance to human application [J]. Reg Anesth Pain Med，2011，36（3）：211-212.
[11] Williams BA，Hough KA，Tsui BYK，et al. Neurotoxicity of adjuvants used in perineural anesthesia and analgesia in comparison with ropivacaine [J]. Reg Anesth Pain Med，2011，36（3）：225-230.
[12] De Oliveira GS Jr，Almeida MD，Benzon HT，et al. Perioperative single dose Systemic dexamethasone for postoperative pain：a meta-analysis of randomized controlled trials [J]. Anesthesiology，2011，115（3）：575-588.
[13] Waldron NH，Jones CA，Gan TJ，et al. Impact of perioperative dexamethasone on postoperative analgesia and side-effects：systematic review and meta-analysis [J]. Br J Anaesth，2013，110（2）：191-200.
[14] Desmet M，Braems H，Reynvoet M，et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery：a prospective，randomized，placebocontrolled study [J]. Br J Anaesth，2013，111（3）：445-452.
[15] Abdallah FW，Johnson J，Chan V，et al. Intravenous and perineural dexamethasone similarly prolong the duration of analgesia after supraclavicular brachial plexus block：a randomized，triple-arm，double-blind，placebo-controlled trial [J]. Reg Anesth Pain Med，2015，40（2）：125-132.
[16] Kawanishi R，Yamamoto K，Tobetto Y，et al. Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine：a prospective randomized trial [J]. Local Reg Anesth，2014，7：5-9.
[17] Fredrickson MJ，Krishnan S，Chen CY. Postoperative analgesia for shoulder surgery：a critical appraisal and review of current techniques [J]. Anaesthesia，2010，65（6）：608-624.
[18] 高辉.地塞米松预防口腔颌面部术后并发症疗效观察[J].中国医药科学，2016，6（20）：203-205.DOI：10.3969/j.issn.2095-0616.2016.20.063.
[19] Jeng CL，Torrillo TM，Rosenblatt MA. Complications of peripheral nerve blocks [J]. British J Anaesth，2010，105（Suppl 1）：i97-i107.
[20] 丁翠霞，于建设，陈冬梅，等.右美托咪定联合地塞米松对小儿鼾症手术全身麻醉苏醒期躁动的影响[J].中国医药，2016，11（4）：588-590.DOI：10.3760/cma.j.issn.1673-4777.2016.04.032.
[21] 刘长东.地塞米松对扁桃体及腺样体射频消融术患儿麻醉苏醒期的影响[J].中国医药科学，2016，6（14）：59-61，72.
[22] Brummett CM，Williams BA. Additives to local anesthetics for peripheral nerve blockade [J]. Int Anesthesiol Clin，2012，49（4）：104-116.
[23] Bjornholdt KT，Monstedt PN，Soballe K，et al. Dexamethasone for pain after outpatient shoulder surgery：a randomised，double-blind，placebo-controlled trial [J]. Acta Anaesthesiol Scand，2014，58（6）：751-758.
2017, Vol. 14 
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