预防周围神经阻滞术后反跳痛：比较静脉注射、硬膜外注射地塞米松和对照组的网络荟萃分析。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-10-24 DOI:10.1016/j.jclinane.2024.111657

Zih-Sian Yang , Hou-Chuan Lai , Hong-Jie Jhou , Wei-Hung Chan , Po-Huang Chen

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引用次数: 0

摘要

研究目的周围神经阻滞（PNB）被广泛用于术后镇痛，但阻滞缓解后的反跳痛是一项重大的临床挑战。静脉注射（IV）或会阴部注射地塞米松有望降低反跳痛的发生率，但最佳途径仍不明确。本网络荟萃分析（NMA）旨在比较地塞米松不同给药途径（包括静脉注射、经皮注射和对照组）在降低PNB术后反跳痛发生率方面的效果：设计：网络荟萃分析：手术室、术后恢复区和病房：七项随机对照试验，涉及 561 名接受周围神经阻滞术后疼痛治疗的患者：干预措施：静脉注射和硬膜外注射地塞米松与对照组比较，以防止反跳痛：主要结果是反跳痛的发生率。次要结果包括首次申请镇痛药的中位时间、反跳痛缓解时间、PNB缓解前后疼痛评分的差异以及恶心/呕吐：主要结果：与对照组相比，静脉注射和硬膜外注射地塞米松均能显著降低周围神经阻滞术后反跳痛的发生率。根据 P 值，静脉注射地塞米松排名第一（OR，0.13；95 % CI，0.07-0.23；P 值，0.92）。次要结果包括首次镇痛请求时间、疼痛评分差异和恶心/呕吐，静脉注射和硬膜外地塞米松均优于对照组：结论：静脉注射和硬膜外注射地塞米松都比不注射地塞米松更能预防腹腔镜手术后的反跳痛，其中静脉注射地塞米松是更有效的途径。尽管存在局限性，但这些发现为术后疼痛管理的临床决策提供了有价值的见解：系统综述注册：PREMCORD42024530943。

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Rebound pain prevention after peripheral nerve block: A network meta-analysis comparing intravenous, perineural dexamethasone, and control

Study objective

Peripheral nerve blocks (PNBs) are widely used for postoperative analgesia, but rebound pain following block resolution poses a significant clinical challenge. Dexamethasone, administered either intravenously (IV) or perineurally, has shown promise in reducing rebound pain incidence, but the optimal route remains unclear. This network meta-analysis (NMA) aims to compare the effectiveness of different routes of dexamethasone administration, including IV, perineural, and control, in reducing the incidence of rebound pain following PNBs.

Design

Network meta-analysis.

Setting

Operating room, postoperative recovery area and ward.

Patients

Seven randomized controlled trials involving 561 patients undergoing peripheral nerve block for postoperative pain management.

Interventions

Intravenous and perineural dexamethasone compared to control for preventing rebound pain.

Measurements

The primary outcome was the incidence of rebound pain. Secondary outcomes included median time to first analgesic request, rebound pain resolution time, difference in pain scores before and after PNB resolution, and nausea/vomiting.

Main results

Both IV and perineural dexamethasone significantly reduced the incidence of rebound pain following peripheral nerve blocks compared to the control group. IV dexamethasone ranked first based on P-score (OR, 0.13; 95 % CI, 0.07–0.23; P-score, 0.92). Secondary outcomes, including time to the first analgesic request, pain score difference, and nausea/vomiting, also favored both IV and perineural dexamethasone over the control group.

Conclusion

Both IV and perineural dexamethasone are preferred over no dexamethasone for preventing rebound pain after PNBs, with IV dexamethasone being the more effective route. Despite limitations, these findings provide valuable insights for clinical decision-making in postoperative pain management.

Systematic review registration: PROSPERO CRD42024530943.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.