Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial.

IF 3.5 2区医学 Q1 ANESTHESIOLOGY Regional Anesthesia and Pain Medicine Pub Date : 2024-08-05 DOI:10.1136/rapm-2023-104520

Youngwon Kim, Seokha Yoo, Sae Hoon Kim, Hansol Kim, Jinyoung Bae, Sun-Kyung Park, Jin-Tae Kim, Young-Jin Lim

{"title":"Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial.","authors":"Youngwon Kim, Seokha Yoo, Sae Hoon Kim, Hansol Kim, Jinyoung Bae, Sun-Kyung Park, Jin-Tae Kim, Young-Jin Lim","doi":"10.1136/rapm-2023-104520","DOIUrl":null,"url":null,"abstract":"Introduction: This study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local anesthetic without intravenous dexamethasone when performing ultrasound-guided superior trunk block in patients undergoing arthroscopic shoulder surgery.Methods: Eighty-four adult patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to receive ultrasound-guided superior trunk block using 7 mL of 0.5% ropivacaine with 0.15 mg/kg of intravenous dexamethasone (treatment group), or 15 mL of 0.5% ropivacaine with intravenous normal saline (control group). The co-primary outcomes were (1) the duration of analgesia (time between block completion and onset of surgical pain with a Numeric Rating Scale pain score of 4 or higher), which was compared against a non-inferiority margin of 3 hours, and (2) the incidence of diaphragmatic paresis evaluated using M-mode ultrasonography in the post-anesthesia care unit.Results: The mean duration of analgesia was 12.4 (6.8) and 11.2 (4.6) hours in the treatment and control groups, respectively (mean difference: -1.2 hours; 95% CI -3.8 to 1.3]; p for non-inferiority<0.001), meeting the non-inferiority criteria. The incidence of diaphragmatic paresis was 45.2% and 85.4% in the treatment and control groups, respectively (relative risk: 0.53; 97.5% CI 0.35 to 0.80; p<0.001).Conclusions: Superior trunk block using low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while providing non-inferior analgesic duration compared with the conventional volume of local anesthetic in patients undergoing arthroscopic shoulder surgery.Trial registration number: Clinical Research Information Service of Republic of Korea Registry (KCT0005998).","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"558-564"},"PeriodicalIF":3.5000,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Regional Anesthesia and Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/rapm-2023-104520","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: This study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local anesthetic without intravenous dexamethasone when performing ultrasound-guided superior trunk block in patients undergoing arthroscopic shoulder surgery.

Methods: Eighty-four adult patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to receive ultrasound-guided superior trunk block using 7 mL of 0.5% ropivacaine with 0.15 mg/kg of intravenous dexamethasone (treatment group), or 15 mL of 0.5% ropivacaine with intravenous normal saline (control group). The co-primary outcomes were (1) the duration of analgesia (time between block completion and onset of surgical pain with a Numeric Rating Scale pain score of 4 or higher), which was compared against a non-inferiority margin of 3 hours, and (2) the incidence of diaphragmatic paresis evaluated using M-mode ultrasonography in the post-anesthesia care unit.

Results: The mean duration of analgesia was 12.4 (6.8) and 11.2 (4.6) hours in the treatment and control groups, respectively (mean difference: -1.2 hours; 95% CI -3.8 to 1.3]; p for non-inferiority<0.001), meeting the non-inferiority criteria. The incidence of diaphragmatic paresis was 45.2% and 85.4% in the treatment and control groups, respectively (relative risk: 0.53; 97.5% CI 0.35 to 0.80; p<0.001).

Conclusions: Superior trunk block using low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while providing non-inferior analgesic duration compared with the conventional volume of local anesthetic in patients undergoing arthroscopic shoulder surgery.

Trial registration number: Clinical Research Information Service of Republic of Korea Registry (KCT0005998).

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

关节镜下肩关节手术后上干阻滞低容量地塞米松静脉局部麻醉与常规容量地塞米松不静脉局部麻醉的比较：一项随机对照非劣效性试验。

引言：本研究旨在研究在关节镜下肩部手术患者进行超声引导下上干阻滞时，与不静脉注射地塞米松的常规体积局部麻醉剂相比，静脉注射地塞米松低体积局部麻醉剂是否可以在保持镇痛持续时间的同时降低膈肌麻痹的发生率外科手术方法：84例在全麻下接受肩关节镜手术的成年患者被随机分配到超声引导下使用7 mL 0.5%罗哌卡因加0.15 mg/kg静脉注射地塞米松（治疗组），或15 0.5%罗哌卡因mL加静脉注射生理盐水（对照组）。共同的主要结果是（1）镇痛的持续时间（阻滞完成和手术疼痛发作之间的时间，数值评定量表疼痛评分为4或更高），与3的非劣效性界限进行比较以及（2）在麻醉后护理室中使用M型超声评估膈肌麻痹的发生率。结果：治疗组和对照组的平均镇痛时间分别为12.4（6.8）和11.2（4.6）小时（平均差异：-1.2 小时；95% CI-3.8至1.3]；p代表非劣效性结论：与常规体积的局部麻醉剂相比，在接受关节镜肩部手术的患者中，使用低体积局部麻醉剂和静脉注射地塞米松的上干阻滞可以降低膈肌麻痹的发生率，同时提供非劣效的镇痛持续时间。试验注册号：韩国临床研究信息服务注册中心（KCT0005998）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Regional Anesthesia and Pain Medicine 医学-麻醉学

CiteScore

8.50

自引率

11.80%

发文量

175

审稿时长

6-12 weeks

期刊介绍： Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).