PDF(Pubmed)
Abstract：
BACKGROUND: The efficacy of perineural vs intravenous dexamethasone as a local anaesthetic adjunct to increase duration of analgesia could be particular to specific peripheral nerve blocks because of differences in systemic absorption depending on the injection site. Given this uncertainty, we performed a systematic review with meta-analysis and trial sequential analysis comparing dexamethasone administered perineurally or intravenously combined with local anaesthetic for interscalene brachial plexus block.
METHODS: Following a search of various electronic databases, we included 11 trials (1145 patients). The primary outcome was the duration of analgesia defined as the time between peripheral nerve block or onset of sensory blockade and the time to first analgesic request or initial report of pain.
RESULTS: The primary outcome, duration of analgesia, was greater in the perineural dexamethasone group, with a mean difference (95% confidence interval) of 122 (62-183) min, I2=73%, P<0.0001. Trial sequential analysis indicated that firm evidence had been reached. The quality of evidence was downgraded to low, mainly because of moderate inconsistency and serious publication bias. No significant differences were present for any of the secondary outcomes, except for onset time of sensory and motor blockade and resting pain score at 12 h, but the magnitude of differences was not clinically relevant.
CONCLUSIONS: There is low-quality evidence that perineural administration of dexamethasone as a local anaesthetic adjunct increases duration of analgesia by an average of 2 h compared with intravenous injection for interscalene brachial plexus block. Given the limited clinical relevance of this difference, the off-label use of perineural administration, and the risk of drug crystallisation, we recommend intravenous dexamethasone administration.
UNASSIGNED: PROSPERO (CRD42023466147).
METHODS: Following a search of various electronic databases, we included 11 trials (1145 patients). The primary outcome was the duration of analgesia defined as the time between peripheral nerve block or onset of sensory blockade and the time to first analgesic request or initial report of pain.
RESULTS: The primary outcome, duration of analgesia, was greater in the perineural dexamethasone group, with a mean difference (95% confidence interval) of 122 (62-183) min, I2=73%, P<0.0001. Trial sequential analysis indicated that firm evidence had been reached. The quality of evidence was downgraded to low, mainly because of moderate inconsistency and serious publication bias. No significant differences were present for any of the secondary outcomes, except for onset time of sensory and motor blockade and resting pain score at 12 h, but the magnitude of differences was not clinically relevant.
CONCLUSIONS: There is low-quality evidence that perineural administration of dexamethasone as a local anaesthetic adjunct increases duration of analgesia by an average of 2 h compared with intravenous injection for interscalene brachial plexus block. Given the limited clinical relevance of this difference, the off-label use of perineural administration, and the risk of drug crystallisation, we recommend intravenous dexamethasone administration.
UNASSIGNED: PROSPERO (CRD42023466147).
摘要：
背景：由于全身吸收的差异，取决于注射部位，神经周与静脉注射地塞米松作为局部麻醉辅助药物以增加镇痛持续时间的功效可能是特定的周围神经阻滞。鉴于这种不确定性，我们采用荟萃分析和试验序贯分析进行了系统评价,比较了经尿道或静脉给予地塞米松联合局部麻醉用于肌间沟臂丛神经阻滞.
方法：搜索各种电子数据库后，我们纳入了11项试验(1145例患者).主要结果是镇痛的持续时间，定义为周围神经阻滞或感觉阻滞发作之间的时间与首次镇痛请求或疼痛的初始报告时间。
结果：主要结果，镇痛持续时间，在神经周地塞米松组中更大，平均差(95%置信区间)为122(62-183)分钟，I2=73%，P<0.0001。试验序贯分析表明，已经取得了确凿的证据。证据质量被降级为低,主要是因为中度不一致和严重的发表偏倚。任何次要结局均无显著差异，除了感觉和运动阻滞的起效时间和12小时的静息疼痛评分，但差异大小与临床无关.
结论：有低质量的证据表明，与静脉内注射肌间沟臂丛神经阻滞相比，神经周给予地塞米松作为局部麻醉辅助药平均增加2小时的镇痛时间。鉴于这种差异的临床相关性有限，标示外使用神经周给药，以及药物结晶的风险，我们建议静脉注射地塞米松.
■PROSPERO（CRD42023466147）。
方法：搜索各种电子数据库后，我们纳入了11项试验(1145例患者).主要结果是镇痛的持续时间，定义为周围神经阻滞或感觉阻滞发作之间的时间与首次镇痛请求或疼痛的初始报告时间。
结果：主要结果，镇痛持续时间，在神经周地塞米松组中更大，平均差(95%置信区间)为122(62-183)分钟，I2=73%，P<0.0001。试验序贯分析表明，已经取得了确凿的证据。证据质量被降级为低,主要是因为中度不一致和严重的发表偏倚。任何次要结局均无显著差异，除了感觉和运动阻滞的起效时间和12小时的静息疼痛评分，但差异大小与临床无关.
结论：有低质量的证据表明，与静脉内注射肌间沟臂丛神经阻滞相比，神经周给予地塞米松作为局部麻醉辅助药平均增加2小时的镇痛时间。鉴于这种差异的临床相关性有限，标示外使用神经周给药，以及药物结晶的风险，我们建议静脉注射地塞米松.
■PROSPERO（CRD42023466147）。
