Reg Anesth Pain Med:选择性全膝关节置换术的局部浸润镇痛中加入地塞米松的效果

2021-08-05 MedSci原创 MedSci原创

全膝关节置换术伴有明显的疼痛,有效的镇痛有利于提高病人的满意度和功能效果。研究表明,地塞米松可能对局部麻醉的作用有促进作用,但这种作用在加入膝关节置换术患者的局部浸润镇痛(LIA)混合物中,还没有得到

全膝关节置换术伴有明显的疼痛,有效的镇痛有利于提高病人的满意度和功能效果。研究表明,地塞米松可能对局部麻醉的作用有促进作用,但这种作用在加入膝关节置换术患者的局部浸润镇痛(LIA)混合物中,还没有得到充分的探讨。近日,一项双盲、随机对照试验探究了局部麻醉剂浸润中加入地塞米松对全膝关节置换术后的镇痛效果的改善效果,研究结果已发表于Reg Anesth Pain Med。

研究纳入140名接受选择性单侧全膝关节置换术的患者,随机分配接受2毫升0.9%生理盐水或2毫升地塞米松4毫克/毫升添加到LIA混合物中。主要结果是24小时的口服吗啡当量消耗。次要结果包括短期和长期镇痛和功能结果以及不良事件。

 

结果,共有72名患者被纳入盐水组,68名被纳入地塞米松组。生理盐水组和地塞米松组24小时的吗啡消耗量相当,中位数分别为60(IQR 40-105(范围16-230))mg和56(IQR 41-75(范围0-300))mg(P=0.096)。与生理盐水相比,地塞米松与住院病人阿片类药物的总消耗量、需要病人控制镇痛的发生率、住院时间和术后恶心的发生率的减少相关。与生理盐水组相比,地塞米松组的病人在术后第1天的关节活动范围和行走距离更大。在休息或活动疼痛评分、定时起床和行走或3个月的结果方面没有差异。

 

综上,该研究结果表明,地塞米松8毫克与24小时的吗啡消耗量没有改善,但与短期镇痛、短期功能、住院时间和术后恶心的适度改善有关。在全膝关节置换术患者的LIA中使用地塞米松没有长期益处。

 

原始出处:

 

Kariem El-Boghdadly, et al., Addition of dexamethasone to local infiltration analgesia in elective total knee arthroplasty: double-blind, randomized control trial. Reg Anesth Pain Med. 2021 Feb;46(2):130-136. doi: 10.1136/rapm-2020-102079.  

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encodeId=f4821548419fa, 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=36, 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=Fri Aug 06 14:46:35 CST 2021, time=2021-08-06, status=1, ipAttribution=)]
    2022-05-03 yxch48
  5. 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encodeId=f4821548419fa, 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=36, 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=Fri Aug 06 14:46:35 CST 2021, time=2021-08-06, status=1, ipAttribution=)]
    2021-08-14 泽兰-

    不错,学习了

    0

  6. 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encodeId=f4821548419fa, 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=36, 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=Fri Aug 06 14:46:35 CST 2021, time=2021-08-06, status=1, ipAttribution=)]
    2021-08-08 种花keke

    术后早期康复锻炼

    0

  7. 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