Dexametasona perineural em bloqueio de plexo braquial interescalênico com levobupivacaína guiado por ultrassonografia para artroscopia de ombro em regime ambulatorial: ensaio clínico controlado e randomizado

IF 1 Q3 Medicine
Mateus Meira Vasconcelos , João Paulo Jordão Pontes , Alexandre de Menezes Rodrigues , Demócrito Ribeiro de Brito Neto , Rodrigo Rodrigues Alves , Fernando Cássio do Prado Silva , Denis Fabiano de Souza
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引用次数: 2

Abstract

Background and objectives

In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting.

Methods

After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound‐guided interscalene brachial plexus block were randomized into Group D – blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C – 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS).

Results

Seventy‐four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant.

Conclusion

Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

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超声引导左布比卡因对肩关节镜门诊的周神经地塞米松阻滞臂间神经丛:一项随机对照临床试验
背景与目的在肩关节镜手术中,门诊患者需要通过局部阻滞来控制术后疼痛。神经周围地塞米松可能延长这些阻滞的效果。本研究的目的是评估神经周地塞米松对门诊关节镜肩关节手术术后感觉阻滞延长的影响。方法经研究伦理委员会批准并获得知情同意后,在全麻和超声引导下进行关节镜肩关节手术的患者随机分为D组和C组,D组为0.5%左布比卡因+血管收缩剂30 mL +地塞米松6 mg (1.5 mL), C组为0.5%左布比卡因+血管收缩剂30 mL + 0.9%生理盐水1.5 mL。评估术后4个时刻(0、4、12、24小时)感觉阻滞持续时间,以及是否需要抢救镇痛、恶心呕吐发生率和视觉模拟疼痛评分(VAS)。结果共招募74例患者,71例完成研究(C组,n = 37;D组,n = 34)。我们的研究结果显示,D组敏感阻滞的平均时间延长(1440±0 min vs 1267±164 min), p <0.001)。根据VAS评分,C组患者的平均疼痛评分较高(2.08±1.72比0.02±0.17,p <0.001)和更多的患者(68.4% vs. 0%, p <0.001)需要在最初24小时内进行抢救性镇痛。术后恶心呕吐发生率无统计学意义。结论神经周地塞米松可明显延长左旋布比卡因引起的斜角肌间臂丛阻滞的感觉阻滞,降低术后疼痛强度和抢救性镇痛需求。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
0
审稿时长
21 weeks
期刊介绍: The Brazilian Journal of Anesthesiology is the official journal of the Brazilian Anesthesiology Society. It publishes articles classified into the following categories: -Scientific articles (clinical or experimental trials)- Clinical information (case reports)- Reviews- Letters to the Editor- Editorials. The journal focuses primarily on clinical trials, with scope on clinical practice, aiming at providing applied tools to the anesthesiologist and critical care physician. The Brazilian Journal of Anesthesiology accepts articles exclusively forwarded to it. Articles already published in other journals are not accepted. All articles proposed for publication are previously submitted to the analysis of two or more members of the Editorial Board or other specialized consultants.
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