Combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane block for postoperative analgesia in gastric cancer patients: A double-blinded randomized controlled trial
Huolin Zeng MD , Feng Yin MD , Lingling Fan MM , Chengyu Li MPH , Hongyan Lin MM , Fei Liu MD , Qian Li MD
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引用次数: 0
Abstract
Study objective
We conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients.
Design
Randomized controlled trial.
Setting
The preoperative area, operating room, postanesthesia recovery room and bed ward.
Patients
A total of 312 adult patients (104 per group) with gastric cancer were included.
Interventions
Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).
Measurements
The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.
Main results
The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04).
Conclusions
The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.
研究目的我们进行了这项双盲随机对照试验,以探讨地塞米松和右美托咪定联合作为腹横肌平面(TAP)阻滞的辅助用药是否能提高胃癌患者的镇痛效果并延长镇痛时间。干预措施患者接受双侧肋下 TAP 阻滞,使用三种不同的麻醉剂(60 毫升 0.测量主要结果是活动 24 小时后中度至重度疼痛的发生率。主要结果A组术后24小时活动时中度至重度疼痛的发生率明显低于B组(45.19% vs 63.46%;RR 0.71;95% CI,0.55~0.92)和C组(45.19% vs 73.08%,RR 0.62;95% CI,0.49~0.79)。24 小时后,移动疼痛评分的中位数明显下降(3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P <0.001)。头 24 小时内阿片类药物的消耗量(27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg;P = 0.01)和首次抢救镇痛的持续时间(65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h;P = 0.04)存在明显差异。结论联合使用地塞米松和右美托咪定作为TAP阻滞的辅助药物可降低胃癌术后24小时内中度至重度疼痛的发生率以及运动和静息时的疼痛评分,并延长首次抢救性镇痛的持续时间:ChiCTR2000037981。
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.