BMJ:全膝关节置换术后使用地塞米松辅助镇痛可降低吗啡使用量缓解疼痛

2022-01-11 MedSci原创 MedSci原创

全膝关节置换术后使用2剂地塞米松可减少术后48小时吗啡消耗量,减少术后疼痛

 

全膝关节置换术是一种常见的手术方法,在世界范围内每年进行超过100万例,而且随着人口老龄化,这一数字预计将显著增加。几乎所有患者术后均会出现中度至重度疼痛。目前全关节置换术后疼痛推荐采用多模式镇痛,包括扑热息痛、布洛芬、局部浸润性镇痛治疗以及吗啡。地塞米松是治疗术后恶心的常见药物,由于其具有抗炎,减少前列腺素合成以及降低神经细胞兴奋性的作用,可用于全膝关节置换后辅助镇痛,但其效果缺少大规模临床验证。近日研究人员探讨地塞米松对全膝关节置换术后疼痛的疗效。


本研究为随机、双盲、安慰剂对照试验,随访90天。在丹麦5家医院开展,485名成年参与者接受了全膝关节置换术,随机分为DX1(术后24小时接受24mg地塞米松+术后48小时安慰剂)、DX2(地塞米松24mg+地塞米松24mg)以及安慰剂(安慰剂+安慰剂)。所有参与者均接受扑热息痛、布洛芬和局部浸润性镇痛治疗。研究的主要终点为术后0至48小时静脉注射吗啡总量,次要结果为术后疼痛。
485名患者参与研究,其中DX1组161名患者,DX2组162名患者,安慰组162名患者,472名患者纳入终点分析。术后0-48小时吗啡消耗的中位数分别为:DX1组 37.9 mg、DX2组 35.0mg、安慰剂43.0mg。术后24小时使用一剂地塞米松可减轻疼痛,48小时使用两剂地塞米松可减轻疼痛。

组间术后吗啡消耗差异

研究认为,全膝关节置换术后使用2剂地塞米松可减少术后48小时吗啡消耗量,减少术后疼痛
原始出处:
Kasper Smidt Gasbjerg et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. BMJ,04 January 2022

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    2022-07-02 yxch48
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    2022-05-13 gaoxiaoe
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time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576828, encodeId=aa9c15e6828e6, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Thu Jan 13 10:15:13 CST 2022, time=2022-01-13, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2058918, encodeId=c1e9205891837, content=<a href='/topic/show?id=6f1ee9219f2' target=_blank style='color:#2F92EE;'>#缓解疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79219, encryptionId=6f1ee9219f2, topicName=缓解疼痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80ca273, createdName=fanweitanzhen, createdTime=Thu Apr 07 10:15:13 CST 2022, time=2022-04-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742782, encodeId=d2381e42782cd, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sat Jul 02 19:15:13 CST 2022, time=2022-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1849358, encodeId=bb0d184935889, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri May 13 06:15:13 CST 2022, time=2022-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1754239, encodeId=d0431e542397f, content=<a href='/topic/show?id=7d3330135ac' target=_blank style='color:#2F92EE;'>#关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, 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  6. [GetPortalCommentsPageByObjectIdResponse(id=2058918, encodeId=c1e9205891837, content=<a href='/topic/show?id=6f1ee9219f2' target=_blank style='color:#2F92EE;'>#缓解疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79219, encryptionId=6f1ee9219f2, topicName=缓解疼痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80ca273, createdName=fanweitanzhen, createdTime=Thu Apr 07 10:15:13 CST 2022, time=2022-04-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742782, encodeId=d2381e42782cd, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, 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channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39153, encryptionId=2013391531d, topicName=吗啡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f0715, createdName=showtest, createdTime=Thu Jan 13 10:15:13 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355370, encodeId=841613553e005, content=<a href='/topic/show?id=256a96e9990' target=_blank style='color:#2F92EE;'>#镇痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96799, encryptionId=256a96e9990, topicName=镇痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jan 13 10:15:13 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390128, encodeId=fbac13901286d, content=<a href='/topic/show?id=c4d0858e23b' target=_blank style='color:#2F92EE;'>#膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85872, encryptionId=c4d0858e23b, topicName=膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Thu Jan 13 10:15:13 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1548420, encodeId=35901548420a0, content=<a href='/topic/show?id=39bf2964295' target=_blank style='color:#2F92EE;'>#全膝关节置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29642, encryptionId=39bf2964295, topicName=全膝关节置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2e4014073525, createdName=12498f6em11暂无昵称, createdTime=Thu Jan 13 10:15:13 CST 2022, time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576828, encodeId=aa9c15e6828e6, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Thu Jan 13 10:15:13 CST 2022, time=2022-01-13, status=1, ipAttribution=)]
    2022-01-13 showtest
  7. 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time=2022-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576828, encodeId=aa9c15e6828e6, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=054816326830, createdName=ms117281293605716, createdTime=Thu Jan 13 10:15:13 CST 2022, time=2022-01-13, status=1, ipAttribution=)]
    2022-01-13 zhaojie88
  8. 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我是一名麻醉医生,不知不觉已经在这个行业工作了35年,每天都在和各种麻醉方式、麻醉药品接触,为无数的患者解释过麻醉的风险、麻醉感觉,回访过无数术后患者,但从未亲身体验过麻醉的真实感受。

刘忠军:多模式镇痛可有效减轻患者脊柱术后疼痛

  脊柱神经丰富,脊柱手术患者术后疼痛明显,程度较重。面对术后镇痛这个棘手的问题,北京大学第三医院骨科主任刘忠军教授认为,多模式镇痛可以有效减轻患者脊柱术后疼痛,是未来脊柱科术后镇痛的发展趋势。   脊柱术后疼痛明显且持续时间长   脊柱手术是临床上常见的创伤性较大的手术之一。通常患者实施脊柱手术的原因主要有:(1) 创伤,如椎体骨折(2) 感染,如椎骨脓肿(3) 

成人日间手术后镇痛专家共识(2017)

日间手术后良好的镇痛,不但有助于预防循环和呼吸系统并发症的发生、改善手术后转归,提高患者满意度,也是保证日间手术平稳进行的必要条件。 手术损伤疼痛相关的组织及神经;手术导致炎性介质释放刺激受损或未受损的神经;术中缺血-再灌注损伤等是术后疼痛的主要原因。某些需术后功能锻炼的患者有较长时间的术后镇痛需求。一些药物可能防止术后急性痛转化为慢性痛,也是手术后镇痛组成需要考虑的因素。

Int J Surg:不同剂量的地佐辛在妇科腹腔镜手术超前镇痛中的有效性和安全性:一项前瞻性、双盲、随机对照临床试验

背景与目的:我国女性生殖系统肿瘤的发病率呈逐年上升趋势,随着发病年龄的年轻化。腹腔镜手术已得到广大医务人员和患者的认可,但术后疼痛仍然存在。因此,采取有效的镇痛措施以减轻患者术后疼痛并同时提高患者的舒适度和满意度,已成为医务工作者关注的焦点。研究的目的是观察不同剂量地佐辛超前镇痛的安全性及对妇科腹腔镜手术患者术后疼痛的影响,以找到地佐辛用于妇科腹腔镜手术术后镇痛的最佳剂量。

气管导管拔管的快捷指南

气管导管的拔管是麻醉中非常关键的阶段,相关并发症常见,有些可造成严重后果甚至死亡。与困难气管插管相比,麻醉医生对气管拔管重要性的认识常常不足。必须规范气管拔管的策略和方法以降低并发症,提高安全性。 气管拔管主要包括四个阶段:①初步计划;②拔管准备;③实施拔管;④拔管后处理(图1)。 图1 气管导管拔管流程图 初步计划 初步拔管计划应该在麻醉

地佐辛术后镇痛专家建议(2018)

地佐辛自2009年在国内上市以来,已在临床中广泛应用,为规范和优化地佐辛的临床应用,国内专家组曾于2013年召开地佐辛术后镇痛专家研讨会,并形成《2013年地佐辛术后镇痛专家建议》,并发表于当年的临床麻醉学杂志。该建议对规范和优化地佐辛的临床应用起到了一定促进作用。近年来,国内积累了大量的地佐辛临床应用资料,并在国内外学术期刊发表,因此有必要对2013年以来的资料进行分析和总结。鉴于文献中大规模、