Gokila Devrajan, Priyanka H Chhabra, Sushil Guria, Kapil Gupta
{"title":"静脉注射地塞米松与神经周地塞米松在超声引导下改良乳房根治术患者脊柱平面阻滞中的比较——一项随机对照试验。","authors":"Gokila Devrajan, Priyanka H Chhabra, Sushil Guria, Kapil Gupta","doi":"10.4103/joacp.joacp_134_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Dexamethasone is used as an adjuvant to prolong the duration of peripheral nerve blocks. This study compares the effectiveness of intravenous (IV) versus perineural dexamethasone as an adjuvant to 0.5% ropivacaine for erector spinae plane block (ESPB) in patients undergoing modified radical mastectomy (MRM).</p><p><strong>Material and methods: </strong>This prospective, double-blind, randomized study was conducted on 60 American Society of Anesthesiologists (ASA) physical status I/II adult females undergoing MRM under general anesthesia. Patients were divided into three groups: ropivacaine perineural dexamethasone (RPD), ropivacaine IV dexamethasone (RID), and ropivacaine normal saline (RNS). Time to rescue analgesia and morphine consumption over various time points (4, 8, 12, 24, and 48 h) were recorded postoperatively. Pain was assessed using the numeric rating scale (NRS).</p><p><strong>Results: </strong>The median time to first rescue analgesia was significantly higher in the RPD group (n = 20) 720 min [interquartile range (IQR: 465-1440), 95% confidence interval (CI): 638.78-1564.21)] in comparison to the RID group (n = 20) 435 min (IQR: 405-480, 95% CI: 284.8-811.1) and control (RNS) group (n = 20) 360 min (IQR: 240-415, 95% CI: 297.6-376.36) (<i>P</i> = 0.01). The median total morphine consumption in 24 h was least in the RPD group 2.0 mg (IQR: 1.0-3.0, 95% CI: 2-3) compared to the the RID 6.0 mg (IQR: 3.2-6.0, 95% CI: 6-8) and RNS groups 7.5 mg (IQR: 6.0-9.5, 95% CI: 6-8) (<i>P</i> = 0.01). The NRS scores both at rest and at physical activity were also lowest in the RPD group compared to other groups at various time points (4, 8,12, 24, and 48 h).</p><p><strong>Conclusions: </strong>Perineural dexamethasone added as an adjuvant to 0.5% ropivacaine to ESPB prolongs the duration of analgesia, reduces morphine consumption, and reduces NRS scores at rest and physical activity as compared to IV dexamethasone in patients undergoing MRM.</p>","PeriodicalId":14946,"journal":{"name":"Journal of Anaesthesiology, Clinical Pharmacology","volume":"41 2","pages":"357-362"},"PeriodicalIF":1.1000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002690/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparison of intravenous with perineural dexamethasone for ultrasound-guided erector spinae plane block in patients undergoing modified radical mastectomy-A randomized control trial.\",\"authors\":\"Gokila Devrajan, Priyanka H Chhabra, Sushil Guria, Kapil Gupta\",\"doi\":\"10.4103/joacp.joacp_134_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Dexamethasone is used as an adjuvant to prolong the duration of peripheral nerve blocks. This study compares the effectiveness of intravenous (IV) versus perineural dexamethasone as an adjuvant to 0.5% ropivacaine for erector spinae plane block (ESPB) in patients undergoing modified radical mastectomy (MRM).</p><p><strong>Material and methods: </strong>This prospective, double-blind, randomized study was conducted on 60 American Society of Anesthesiologists (ASA) physical status I/II adult females undergoing MRM under general anesthesia. Patients were divided into three groups: ropivacaine perineural dexamethasone (RPD), ropivacaine IV dexamethasone (RID), and ropivacaine normal saline (RNS). Time to rescue analgesia and morphine consumption over various time points (4, 8, 12, 24, and 48 h) were recorded postoperatively. Pain was assessed using the numeric rating scale (NRS).</p><p><strong>Results: </strong>The median time to first rescue analgesia was significantly higher in the RPD group (n = 20) 720 min [interquartile range (IQR: 465-1440), 95% confidence interval (CI): 638.78-1564.21)] in comparison to the RID group (n = 20) 435 min (IQR: 405-480, 95% CI: 284.8-811.1) and control (RNS) group (n = 20) 360 min (IQR: 240-415, 95% CI: 297.6-376.36) (<i>P</i> = 0.01). The median total morphine consumption in 24 h was least in the RPD group 2.0 mg (IQR: 1.0-3.0, 95% CI: 2-3) compared to the the RID 6.0 mg (IQR: 3.2-6.0, 95% CI: 6-8) and RNS groups 7.5 mg (IQR: 6.0-9.5, 95% CI: 6-8) (<i>P</i> = 0.01). The NRS scores both at rest and at physical activity were also lowest in the RPD group compared to other groups at various time points (4, 8,12, 24, and 48 h).</p><p><strong>Conclusions: </strong>Perineural dexamethasone added as an adjuvant to 0.5% ropivacaine to ESPB prolongs the duration of analgesia, reduces morphine consumption, and reduces NRS scores at rest and physical activity as compared to IV dexamethasone in patients undergoing MRM.</p>\",\"PeriodicalId\":14946,\"journal\":{\"name\":\"Journal of Anaesthesiology, Clinical Pharmacology\",\"volume\":\"41 2\",\"pages\":\"357-362\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002690/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Anaesthesiology, Clinical Pharmacology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/joacp.joacp_134_24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Anaesthesiology, Clinical Pharmacology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/joacp.joacp_134_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/24 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
Comparison of intravenous with perineural dexamethasone for ultrasound-guided erector spinae plane block in patients undergoing modified radical mastectomy-A randomized control trial.
Background and aims: Dexamethasone is used as an adjuvant to prolong the duration of peripheral nerve blocks. This study compares the effectiveness of intravenous (IV) versus perineural dexamethasone as an adjuvant to 0.5% ropivacaine for erector spinae plane block (ESPB) in patients undergoing modified radical mastectomy (MRM).
Material and methods: This prospective, double-blind, randomized study was conducted on 60 American Society of Anesthesiologists (ASA) physical status I/II adult females undergoing MRM under general anesthesia. Patients were divided into three groups: ropivacaine perineural dexamethasone (RPD), ropivacaine IV dexamethasone (RID), and ropivacaine normal saline (RNS). Time to rescue analgesia and morphine consumption over various time points (4, 8, 12, 24, and 48 h) were recorded postoperatively. Pain was assessed using the numeric rating scale (NRS).
Results: The median time to first rescue analgesia was significantly higher in the RPD group (n = 20) 720 min [interquartile range (IQR: 465-1440), 95% confidence interval (CI): 638.78-1564.21)] in comparison to the RID group (n = 20) 435 min (IQR: 405-480, 95% CI: 284.8-811.1) and control (RNS) group (n = 20) 360 min (IQR: 240-415, 95% CI: 297.6-376.36) (P = 0.01). The median total morphine consumption in 24 h was least in the RPD group 2.0 mg (IQR: 1.0-3.0, 95% CI: 2-3) compared to the the RID 6.0 mg (IQR: 3.2-6.0, 95% CI: 6-8) and RNS groups 7.5 mg (IQR: 6.0-9.5, 95% CI: 6-8) (P = 0.01). The NRS scores both at rest and at physical activity were also lowest in the RPD group compared to other groups at various time points (4, 8,12, 24, and 48 h).
Conclusions: Perineural dexamethasone added as an adjuvant to 0.5% ropivacaine to ESPB prolongs the duration of analgesia, reduces morphine consumption, and reduces NRS scores at rest and physical activity as compared to IV dexamethasone in patients undergoing MRM.
期刊介绍：
The JOACP publishes original peer-reviewed research and clinical work in all branches of anaesthesiology, pain, critical care and perioperative medicine including the application to basic sciences. In addition, the journal publishes review articles, special articles, brief communications/reports, case reports, and reports of new equipment, letters to editor, book reviews and obituaries. It is international in scope and comprehensive in coverage.
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