[罂粟摘要]静脉注射右美托咪定联合地塞米松用于关节镜下肩袖修复术的肌间沟阻滞持续时间的一项随机对照试验

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静脉注射右美托咪定联合地塞米松用于关节镜下肩袖修复术的肌间沟阻滞持续时间的一项随机对照试验

贵州医科大学   麻醉与心脏电生理课题

翻译:  胡廷菊

编辑:  严旭

审校: 曹莹

背景:

静脉注射右美托咪定所致周围神经阻滞的延长时间可因静脉注射地塞米松再延长。

方法：

拟行日间关节镜下肩袖修复术的122名患者，肌间沟臂丛神经阻滞前静脉注射地塞米松0.15mg/kg，随机分为静脉注射生理盐水组（62名参与者）或静脉注射右美托咪定组1μg/kg（60名参与者）。主要观察指标是在术后48小时内，从神经阻滞到首次口服吗啡的时间。

 结果：

59名参与者口服吗啡，安慰剂组为25/62，右美托咪定组为34/60，p = 0.10。给与右美托咪定后需要口服吗啡的时间较短，危险比（95%CI）1.68（1.00–2.82），p = 0.049。吗啡剂量的中位数(IQR）对照组为0（0-12.5[0–50]）mg，右美托咪定组为10（0-30[0–50]），差值（95%CI）为7（0-10）mg，p = 0.056。右美托咪定对静息和运动时疼痛均无影响。安慰剂组和右美托咪定组术中低血压分别为27/62和50/60，p<0.001。其他的结果也很相似，包括感觉和运动阻滞的持续时间。

结论：

总之，右美托咪定联合地塞米松静脉注射缩短了肌间沟阻滞后口服吗啡的时间并引起术中低血压。

原始文献来源：

Albrecht E, Capel D, Rossel JB, Wolmarans MR, Godenèche A, De Paulis D, Cabaton J. A randomised controlled trial of intravenous dexmedetomidine added to dexamethasone for arthroscopic rotator cuff repair and duration of interscalene block. Anaesthesia. 2023 Mar;78(3):315-319. doi: 10.1111/anae.15942. Epub 2022 Dec 14. PMID: 36515126.

英文原文：

A randomised controlled trial of intravenous dexmedetomidine added to dexamethasone for arthroscopic rotator cuff repair and duration of interscalene block

Abstract

Background:Prolongation of peripheral nerve blockade by intravenous dexamethasone may beextended by intravenous dexmedetomidine.   

Methods: We randomly allocated 122 participants who had intravenous dexamethasone 0.15 mg.kg 1 before interscalene brachial plexus block for day-case arthroscopic rotator cuff repair to intravenous saline (62 participants) or intravenous dexmedetomidine 1 lg.kg 1 (60 participants). The primary outcome was time from block to first oral morphine intake during the first 48 postoperative hours.

Results: Fifty-nine participants reported taking oral morphine, 25/62 after placebo and 34/60 after dexmedetomidine, p = 0.10. The time to morphine intake was shorter after dexmedetomidine, hazard ratio (95%CI) 1.68 (1.00–2.82), p = 0.049. Median (IQR [range]) morphine doses were 0 (0–12.5 [0–50]) mg after control vs. 10 (0–30 [0–50]) after dexmedetomidine, a difference (95%CI) of 7 (0–10) mg, p = 0.056. There was no effect of dexmedetomidine on pain at rest or on movement. Intra-operative hypotension was recorded for 27/62 and 50/60 participants after placebo vs. dexmedetomidine, respectively, p < 0.001. Other outcomes were similar, including durations of sensory and motor block.

Conclusions:In conclusion, dexmedetomidine shortened the time to oral morphine consumption after interscalene block combined with dexamethasone and caused intra-operative hypotension.

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