The effect of intravenous dexamethasone on rebound pain after wrist and hand surgery under supraclavicular brachial plexus blockade: a randomized placebo-controlled trial.

IF 3.3 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2025-07-01 Epub Date: 2025-06-20 DOI:10.1007/s12630-025-02992-6

RyungA Kang, Yu Jeong Bang, Jae Woo Shim, Soo Joo Choi, So Myung Kong, Tae Soo Hahm, Jungchan Park, Woo Seog Sim, Justin Sangwook Ko

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引用次数: 0

Abstract

Purpose: We sought to evaluate the efficacy of intravenous dexamethasone in reducing rebound pain post-orthopedic wrist and hand surgery, administered prior to supraclavicular brachial plexus blockade.

Methods: We conducted a randomized placebo-controlled trial on 56 patients scheduled for elective wrist and hand surgery under supraclavicular brachial plexus blockade. We randomized participants into either a control group, receiving 0.9% of intravenous saline, or a dexamethasone group, receiving 0.11 mg·kg^-1 of intravenous dexamethasone. The primary outcome was the difference in pain scores before vs after block resolution. Secondary outcomes included the incidence of rebound pain, pain scores, cumulative opioid consumption, patient satisfaction with postoperative analgesia, and block-related complications in the first 24 hr postoperatively.

Results: The mean (standard deviation [SD]) pain score difference was significantly larger in the control group (7.3 [1.9]) compared with the dexamethasone group (4.7 [2.1]), with a mean difference between groups of 2.6 (95% confidence interval, 1.5 to 3.7; P < 0.001). The incidence of rebound pain was also significantly higher in the control group (79% vs 32%; P < 0.001). The cumulative opioid consumption in 24 hr was greater in the control group than in the dexamethasone group (median [interquartile range (IQR)], 72 [54-97] mg vs 25 [14-60] mg; P < 0.001). We found no significant differences in postoperative complications.

Conclusions: Preoperative administration of 0.11 mg·kg^-1 intravenous dexamethasone significantly reduced rebound pain within 24 hr after wrist and hand surgery under supraclavicular brachial plexus blockade. The results of our trial support the use of intravenous dexamethasone as an effective method for managing postoperative pain for wrist and hand surgery under supraclavicular brachial plexus blockade.

Study registration: www.CRIS.nih.go.kr ( KCT0007208 ); first submitted 5 April 2022.

查看原文本刊更多论文

静脉注射地塞米松对锁骨上臂丛阻滞腕部和手部手术后反弹疼痛的影响：一项随机安慰剂对照试验。

目的：我们试图评估静脉注射地塞米松在减少矫形手腕和手部手术后反跳疼痛的疗效，在锁骨上臂丛阻滞之前给予。方法：我们对56例在锁骨上臂丛阻滞下计划择期腕部和手部手术的患者进行随机安慰剂对照试验。我们将参与者随机分为对照组（0.9%静脉生理盐水）和地塞米松组（0.11 mg·kg-1静脉地塞米松）。主要观察结果是阻滞缓解前后疼痛评分的差异。次要结局包括术后24小时内反跳疼痛发生率、疼痛评分、累计阿片类药物消耗、患者对术后镇痛的满意度和阻滞相关并发症。结果：对照组的平均（标准差[SD]）疼痛评分差异（7.3[1.9]）明显大于地塞米松组（4.7[2.1]），组间平均差异为2.6(95%可信区间，1.5 ~ 3.7；结论：在锁骨上臂丛阻滞下，术前静脉给予0.11 mg·kg-1地塞米松可显著减轻腕手手术后24小时内的反跳性疼痛。我们的试验结果支持静脉注射地塞米松作为治疗锁骨上臂丛阻滞下腕手手术术后疼痛的有效方法。研究注册：www.CRIS.nih.go.kr (KCT0007208)；首次提交于2022年4月5日。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.