Abstract：
OBJECTIVE: We conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients.
METHODS: Randomized controlled trial.
METHODS: The preoperative area, operating room, postanesthesia recovery room and bed ward.
METHODS: A total of 312 adult patients (104 per group) with gastric cancer were included.
METHODS: Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).
METHODS: The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.
RESULTS: The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04).
CONCLUSIONS: The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.
BACKGROUND: ChiCTR2000037981.
METHODS: Randomized controlled trial.
METHODS: The preoperative area, operating room, postanesthesia recovery room and bed ward.
METHODS: A total of 312 adult patients (104 per group) with gastric cancer were included.
METHODS: Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).
METHODS: The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.
RESULTS: The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04).
CONCLUSIONS: The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.
BACKGROUND: ChiCTR2000037981.
摘要：
目的：我们进行了这项双盲随机对照试验，以研究地塞米松和右美托咪定联合作为腹横肌平面（TAP）阻滞的佐剂是否可以改善胃癌患者的镇痛效果和持续时间。
方法：随机对照试验。
方法：术前区域，手术室,麻醉后恢复室和病床病房。
方法：共纳入312例成人胃癌患者（每组104例）。
方法：患者接受三种不同麻醉药的双侧肋下TAP阻滞（60ml0.25％罗哌卡因加10mg地塞米松和1μg·kg-1右美托咪定[A]或10mg地塞米松[B]或1μg·kg-1右美托咪定[C]）。
方法：主要结果是24h运动时中度至重度疼痛的发生率。次要结果包括中度至重度疼痛的发生率，疼痛评分,阿片类药物的使用，恢复质量和不良事件。
结果：A组术后24h运动时中重度疼痛的发生率明显低于B组（45.19％vs63.46％；RR0.71；95％CI，0.55至0.92）和C组（45.19％vs73.08％，RR0.62；95%CI，0.49至0.79）。中位运动疼痛评分在24h时显著降低(3.00[3.00,5.00]vs4.00[3.00,6.00]vs4.00[3.00,5.00];P<0.001)。前24小时内阿片类药物的消耗量存在显着差异（27.5[17.0,37.2]vs30.0[20.0,42.0]vs32.0[25.0,44.0]mg；P=0.01），首次抢救镇痛的持续时间（65.5±26.7vs45.9±34.5vs49.2±27.2h；P=0.04）。
结论：联合地塞米松和右美托咪定作为TAP阻滞佐剂可降低胃癌术后24h运动和静息时的中重度疼痛发生率和疼痛评分，延长首次抢救镇痛时间。
背景：ChiCTR2000037981。
方法：随机对照试验。
方法：术前区域，手术室,麻醉后恢复室和病床病房。
方法：共纳入312例成人胃癌患者（每组104例）。
方法：患者接受三种不同麻醉药的双侧肋下TAP阻滞（60ml0.25％罗哌卡因加10mg地塞米松和1μg·kg-1右美托咪定[A]或10mg地塞米松[B]或1μg·kg-1右美托咪定[C]）。
方法：主要结果是24h运动时中度至重度疼痛的发生率。次要结果包括中度至重度疼痛的发生率，疼痛评分,阿片类药物的使用，恢复质量和不良事件。
结果：A组术后24h运动时中重度疼痛的发生率明显低于B组（45.19％vs63.46％；RR0.71；95％CI，0.55至0.92）和C组（45.19％vs73.08％，RR0.62；95%CI，0.49至0.79）。中位运动疼痛评分在24h时显著降低(3.00[3.00,5.00]vs4.00[3.00,6.00]vs4.00[3.00,5.00];P<0.001)。前24小时内阿片类药物的消耗量存在显着差异（27.5[17.0,37.2]vs30.0[20.0,42.0]vs32.0[25.0,44.0]mg；P=0.01），首次抢救镇痛的持续时间（65.5±26.7vs45.9±34.5vs49.2±27.2h；P=0.04）。
结论：联合地塞米松和右美托咪定作为TAP阻滞佐剂可降低胃癌术后24h运动和静息时的中重度疼痛发生率和疼痛评分，延长首次抢救镇痛时间。
背景：ChiCTR2000037981。
