Efficacy and safety of adjuvant intrathecal dexamethasone during spinal anesthesia: A systematic review and meta-analysis

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-06-04 DOI:10.4103/sja.sja_112_24

T. Tantry, Vasantha Shetty, Aarti Deepak, Sumesh Murali, Murali S. B. Golitadka, Shreejith K. Menon, Sunil P. Shenoy, Dinesh Kadam

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引用次数: 0

Abstract

The use of intrathecal (IT) dexamethasone during subarachnoid block (SAB) has not been evaluated. There are no pooled data available to decide on the optimal regimen of IT dexamethasone during SAB, irrespective of the type of surgery. There is uncertainty about its dosage, effectiveness, and safety, and a need to establish clear guidelines on its use. Our objective was to evaluate the effectiveness and safety of use of IT dexamethasone during SAB. We performed a meta-analysis (PROSPERO, CRD42022304944) of trials that included patients who underwent a variety of surgical procedures under SAB. Patients received concomitant IT dexamethasone as an adjuvant to spinal local anesthetics. The analyzed outcomes included sensory and motor effects as well as adverse and/or beneficial side effects. Subgroup analysis was planned based on different doses used. Trial sequential analysis (TSA) was used to estimate the required sample size information (RIS) for each outcome. Eighteen studies (2531 participants) were included in this analysis. Addition of IT dexamethasone (4-8 mg) to heavy bupivacaine effectively prolonged the duration of sensory blockade (mean difference, MD = 63.8 minutes; [95% confidence interval, CI, 33.1-94.5], P < 0.0001), two-segment regression time (MD = 20.1[95% CI, 0.96-39.2], P = 0.04) and first rescue analgesic time (MD = 143.3 [95% CI, 90.3-196.0], P = 0.001). Subgroup analyses revealed superior effects of 8 mg dose over 4 mg for sensory and analgesic effects. The effect of dexamethasone on duration of motor blockade was inconclusive. Additionally, lower risk ratios (RRs) were recorded for spinal anesthesia-related hypotension (RR = 0.74 [95% CI, 0.6-0.9], P = 0.0003) and nausea/vomiting (RR = 0.62 [95% CI, 0.41-0.93], P = 0.02) in the dexamethasone group. For outcomes such as sensory blockade, analgesia, and hypotension, the required information size was reached during TSA. In conclusion, IT dexamethasone, used as an adjuvant to spinal local anesthetic, especially at the dose of 8 mg, increases sensory blockade duration and the time for request of the first rescue analgesic. SAB-induced side effects such as hypotension, nausea, and vomiting are lesser with the use of IT dexamethasone. However, further studies are necessary to draw meaningful conclusions on its safety profile.

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脊髓麻醉期间鞘内地塞米松辅助治疗的有效性和安全性：系统回顾和荟萃分析

蛛网膜下腔阻滞（SAB）期间使用鞘内地塞米松的情况尚未进行评估。目前还没有综合数据来确定蛛网膜下腔阻滞期间使用 IT 地塞米松的最佳方案，无论手术类型如何。地塞米松的剂量、有效性和安全性都存在不确定性，因此需要制定明确的使用指南。我们的目的是评估在 SAB 期间使用 IT 地塞米松的有效性和安全性。我们进行了一项荟萃分析（PROSPERO，CRD42022304944），研究对象包括在 SAB 下接受各种外科手术的患者。患者同时接受 IT 地塞米松作为脊髓局麻药的辅助药物。分析结果包括感觉和运动影响以及不良和/或有益副作用。根据所用剂量的不同，计划进行分组分析。试验序列分析（TSA）用于估算每种结果所需的样本量信息（RIS）。本次分析共纳入了 18 项研究（2531 名参与者）。在重型布比卡因中加入 IT 地塞米松（4-8 毫克）可有效延长感觉阻滞的持续时间（平均差，MD = 63.8 分钟；[95% 置信区间，CI，33.1-94.5]，P < 0.0001）、两段回归时间（MD = 20.1[95% CI, 0.96-39.2]，P = 0.04）和首次镇痛抢救时间（MD = 143.3 [95% CI, 90.3-196.0]，P = 0.001）。分组分析显示，8 毫克剂量的感觉和镇痛效果优于 4 毫克。地塞米松对运动阻滞持续时间的影响尚无定论。此外，地塞米松组脊髓麻醉相关低血压（RR = 0.74 [95% CI, 0.6-0.9]，P = 0.0003）和恶心/呕吐（RR = 0.62 [95% CI, 0.41-0.93]，P = 0.02）的风险比（RRs）较低。对于感觉阻滞、镇痛和低血压等结果，TSA期间达到了所需的信息量。总之，IT 地塞米松作为脊髓局麻药的辅助用药，尤其是 8 毫克剂量时，可延长感觉阻滞时间，并延长首次申请抢救性镇痛药的时间。使用 IT 地塞米松后，SAB 引起的低血压、恶心和呕吐等副作用会减少。不过，要对其安全性得出有意义的结论，还需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.