Effect of perineural dexamethasone versus dexmedetomidine as adjuvants to ropivacaine on analgesic duration in pediatric popliteal sciatic nerve blocks: a randomized, triple-blinded, placebo-controlled trial.

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

Regional Anesthesia and Pain Medicine Pub Date : 2025-10-02 DOI:10.1136/rapm-2025-107096

Tomasz Reysner, Pawel Pietraszek, Milud Shadi, Bartosz Musielak, Grzegorz Kowalski, Przemysław Daroszewski, Malgorzata Reysner

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引用次数: 0

Abstract

Background: Concerns about opioid-related adverse effects and local anesthetic toxicity often limit effective postoperative pain management in pediatric patients. This study aimed to compare the analgesic efficacy and systemic effects of perineural dexamethasone (DEX) versus dexmedetomidine (DEM) when used as adjuvants to ropivacaine in pediatric popliteal sciatic nerve blocks.

Methods: In this triple-blinded, randomized controlled trial, 90 children aged 3 months to 7 years (American Society of Anesthesiologists (ASA) I-III) undergoing elective foot or ankle surgery at a single academic center were randomized to receive ultrasound-guided popliteal sciatic nerve blocks with 0.2% ropivacaine combined with either DEX (0.1 mg/kg), DEM (0.1 µg/kg), or saline (placebo). The primary outcome was time to first rescue opioid administration. Secondary outcomes included total opioid consumption (µg/kg nalbuphine), Face-Legs-Activity-Cry-Consolability (FLACC) pain scores at predefined intervals (4-48 hours) and systemic inflammatory markers (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio). Statistical analysis included Kruskal-Wallis and Fisher's exact tests with Bonferroni correction.

Results: Mean time to first opioid use was 19.4 ± 2.0 hours for DEX, 18.4 ± 1.7 hours for DEM, and 8.5 ± 1.2 hours for placebo (p < 0.0001); the difference between DEX and DEM was 1.0 hour (95% CI 0.04 to 2.06; p=0.0400). Nalbuphine was required in 23.3% of DEX, 33.3% of DEM, and 90% of placebo patients. Total opioid consumption was lower in adjuvant groups (DEX, 40.0 ± 77.0 µg/kg; DEM, 46.7 ± 73.0 µg/kg) compared with placebo (123.3 ± 62.6 µg/kg). FLACC scores were significantly reduced at 6, 8, and 12 hours in both adjuvant groups. NLR at 48 hours was significantly lower in the dexamethasone group (p=0.0136). No nerve injuries or hemodynamic complications occurred.

Conclusions: Both adjuvants prolonged analgesia and reduced opioid requirements. Although DEX produced slightly longer analgesia than DEM, the clinical significance of this difference may be limited. Larger studies are needed to confirm safety.

Trial registration number: ClinicalTrials.gov Identifier: NCT06233565.

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围神经地塞米松与右美托咪定辅助罗哌卡因对小儿腘窝坐骨神经阻滞镇痛持续时间的影响：一项随机、三盲、安慰剂对照试验。

背景：对阿片类药物相关不良反应和局部麻醉毒性的担忧往往限制了儿科患者术后疼痛的有效管理。本研究旨在比较神经周地塞米松（DEX）与右美托咪定（DEM）在小儿腘窝坐骨神经阻滞中作为罗哌卡因佐剂的镇痛效果和全身效应。方法：在这项三盲、随机对照试验中，90名3个月至7岁的儿童（美国麻醉医师协会（ASA） I-III）在单一学术中心接受选择性足部或踝关节手术，随机接受超声引导下0.2%罗哌卡因联合DEX （0.1 mg/kg）、DEM （0.1 μ g/kg）或生理盐水（安慰剂）的腘窝坐骨神经阻滞。主要结局是阿片类药物首次抢救的时间。次要结局包括阿片类药物总消耗量（µg/kg纳布啡）、面部-腿部-活动-哭泣-安慰（FLACC）疼痛评分（预定间隔4-48小时）和全身炎症标志物（中性粒细胞与淋巴细胞比率（NLR）和血小板与淋巴细胞比率）。统计分析包括Kruskal-Wallis和Fisher的精确检验和Bonferroni校正。结果：DEX首次使用阿片类药物的平均时间为19.4 ± 2.0小时，DEM为18.4 ± 1.7小时，安慰剂为8.5 ± 1.2小时（p ）结论：两种佐剂均延长了镇痛时间，减少了阿片类药物的需求。虽然DEX比DEM的镇痛时间稍长，但这种差异的临床意义可能有限。需要更大规模的研究来证实其安全性。试验注册号：ClinicalTrials.gov标识符：NCT06233565。

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来源期刊

Regional Anesthesia and Pain Medicine 医学-麻醉学

CiteScore

8.50

自引率

11.80%

发文量

175

审稿时长

6-12 weeks

期刊介绍： Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).