静脉注射地塞米松与硬膜外地塞米松作为下肢周围神经阻滞的局部麻醉辅助药物的比较:荟萃分析和系统综述。

IF 4.2 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-10 DOI:10.1097/EJA.0000000000002038
Neel Desai, Suji Pararajasingham, Desire Onwochei, Eric Albrecht
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引用次数: 0

摘要

背景:作为局麻药的辅助用药,下肢硬膜外地塞米松的全身吸收可能会受到限制,因为与上肢相比,下肢血管较少:比较下肢静脉注射和硬膜外注射地塞米松的药效学特征:设计:对随机对照试验进行系统回顾和荟萃分析:截至2023年7月18日,对Central、Google Scholar、Ovid Embase和Ovid Medline进行了系统检索:随机对照试验,比较静脉注射地塞米松和硬膜外注射地塞米松作为下肢手术周围神经阻滞的局麻药辅助用药:最常见的周围神经阻滞是股神经、坐骨神经和踝关节阻滞。所有试验中的局麻药都是长效的,大多数试验中的地塞米松剂量为 8 毫克。所有九项试验(n = 546 名患者)都对主要结果--镇痛持续时间进行了调查。总体而言,与静脉注射地塞米松相比,硬膜外地塞米松可将镇痛持续时间从19.54小时延长至22.27小时,平均差异[95%置信区间(CI)为2.73(1.07至4.38)小时;P = 0.001,I2 = 87]。由于严重不一致,证据质量为中等。然而,根据周围神经阻滞的位置、局麻药的类型或硬膜外肾上腺素的使用情况进行的分析表明,静脉注射地塞米松和硬膜外地塞米松在持续时间上没有差异。在与疗效和副作用相关的次要结果中也未显示出差异:总之,中等程度的证据表明,在延长镇痛持续时间方面,硬膜外地塞米松优于静脉注射地塞米松。不过,这种差异不太可能与临床相关。在考虑经皮使用地塞米松时,应认识到这种给药途径仍未列入标签。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of intravenous versus perineural dexamethasone as a local anaesthetic adjunct for peripheral nerve blocks in the lower limb: A meta-analysis and systematic review.

Background: As a local anaesthetic adjunct, the systemic absorption of perineural dexamethasone in the lower limb could be restricted because of decreased vascularity when compared with the upper limb.

Objectives: To compare the pharmacodynamic characteristics of intravenous and perineural dexamethasone in the lower limb.

Design: Systematic review of randomised controlled trials with meta-analysis.

Data sources: Systematic search of Central, Google Scholar, Ovid Embase and Ovid Medline to 18 July 2023.

Eligibility criteria: Randomised controlled trials, which compared the intravenous with perineural administration of dexamethasone as a local anaesthetic adjunct in peripheral nerve blocks for surgery of the lower limb.

Results: The most common peripheral nerve blocks were femoral, sciatic and ankle block. The local anaesthetic was long acting in all trials and the dose of dexamethasone was 8 mg in most trials. The primary outcome, the duration of analgesia, was investigated by all nine trials ( n  = 546 patients). Overall, compared with intravenous dexamethasone, perineural dexamethasone increased the duration of analgesia from 19.54 to 22.27 h, a mean difference [95% confidence interval (CI) of 2.73 (1.07 to 4.38) h; P  = 0.001, I2  = 87]. The quality of evidence was moderate owing to serious inconsistency. However, analysis based on the location of the peripheral nerve block, the type of local anaesthetic or the use of perineural adrenaline showed no difference in duration between intravenous and perineural dexamethasone. No differences were shown for any of the secondary outcomes related to efficacy and side effects.

Conclusion: In summary, moderate evidence supports the superiority of perineural dexamethasone over intravenous dexamethasone in prolonging the duration of analgesia. However, this difference is unlikely to be clinically relevant. Consideration of the perineural use of dexamethasone should recognise that this route of administration remains off label.

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来源期刊
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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