Brazilian Journal of Anesthesiology最新文献_第10页

Gender representation in anesthesiology research: a historical perspective from the Brazilian Journal of Anesthesiology 麻醉学研究中的性别代表性：来自《巴西麻醉学杂志》的历史视角。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-03 DOI: 10.1016/j.bjane.2024.844584

Stefania Lacerda Garcia , Claudia Marquez Simões , Maria José Carvalho Carmona , Liana Maria Tôrres de Araújo Azi

引用次数: 0

The use of methylene blue in adult patients with septic shock: a systematic review and meta-analysis 亚甲基蓝在成人脓毒性休克患者中的应用：一项系统回顾和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-01 DOI: 10.1016/j.bjane.2024.844580

Ka Ting Ng , Pei En Kwok , Wei En Lim , Wan Yi Teoh , Mohd Shahnaz Hasan , Mohd Fitry Zainal Abidin

Objectives

Methylene blue exerts its vasopressor properties by inhibiting nitric oxide-mediated vasodilation. Recent studies have advocated the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock.

Methods

Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until October 2023. Randomized Clinical Trials (RCT) comparing methylene blue and placebo in adults with septic shock were included.

Results

Our systematic review included 5 studies (n = 257) for data analysis. As compared to the placebo, our pooled analysis showed that methylene blue significantly increased mean arterial pressure (MD: 1.34 mmHg, 95% CI 0.15 to 2.53, p = 0.03, level of evidence: very low). Patients who were given methylene blue were associated with statistically lower mortality rate (OR = 0.49, 95% CI 0.27 to 0.88, p = 0.02, level of evidence: low), reduced serum lactate levels (MD: -0.76 mmoL.L^-1, 95% CI -1.22 to -0.31, p = 0.0009, level of evidence: low), reduced length of hospital stay (MD: -1.94 days, 95% CI -3.79 to -0.08, p = 0.04, level of evidence: low), and increased PaO₂/FiO₂ (MD: 34.78, 95% CI 8.94 to 60.61, p = 0.008, level of evidence: low).

Conclusions

This meta-analysis demonstrated that methylene blue administration was associated with an increased in mean arterial pressure and PaO₂/FiO₂ ratio, along with a reduction in mortality rates, serum lactate levels, and length of hospital stay. However, substantial degree of heterogeneity and inadequate number of studies with low level of evidence warrant future adequately powered RCTs to affirm our results.

目的：亚甲基蓝通过抑制一氧化氮介导的血管舒张发挥其血管加压特性。最近的研究提倡使用亚甲基蓝作为脓毒性休克患者的抢救治疗。主要目的是研究亚甲基蓝对脓毒性休克成年患者平均动脉压的影响。方法：检索MEDLINE、EMBASE和CENTRAL数据库，检索时间为建站日期至2023年10月。随机临床试验（RCT）比较亚甲基蓝和安慰剂在成人感染性休克。结果：我们的系统综述纳入了5项研究（n = 257）进行数据分析。与安慰剂相比，我们的合并分析显示亚甲基蓝显著增加了平均动脉压（MD: 1.34 mmHg, 95% CI 0.15至2.53,p = 0.03，证据水平非常低）。给予亚甲基蓝的患者死亡率降低（OR = 0.49,95% CI 0.27 ~ 0.88, p = 0.02，证据水平低），血清乳酸水平降低（MD: -0.76 mmoL）。L-1, 95% CI -1.22 ~ -0.31, p = 0.0009，证据水平低)，住院时间缩短（MD: -1.94天，95% CI -3.79 ~ -0.08, p = 0.04，证据水平低），PaO2/FiO2增加（MD: 34.78, 95% CI 8.94 ~ 60.61, p = 0.008，证据水平低）。结论：该荟萃分析表明，亚甲蓝给药与平均动脉压和PaO2/FiO2比值升高相关，同时降低死亡率、血清乳酸水平和住院时间。然而，大量的异质性和低水平证据的研究数量不足，需要未来足够有力的随机对照试验来证实我们的结果。

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引用次数: 0

Shaping the future of anesthesia research: celebrating progress and embracing new challenges 塑造麻醉研究的未来：庆祝进步，迎接新挑战。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-01 DOI: 10.1016/j.bjane.2024.844582

Andre P. Schmidt

引用次数: 0

The impact of patient- and family-centered care interventions on intensive care unit outcomes: a meta-analysis of randomized controlled trials 以患者和家庭为中心的护理干预对重症监护病房结果的影响：随机对照试验的荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-01 DOI: 10.1016/j.bjane.2024.844577

Yangjin LV , Peng Li , Ronghui Li , Ting Zhang , Kaifang Cai

Background

Patient and Family-Centered Care (PFCC) interventions are increasingly recognized as a viable approach to address various mental health issues among patients in Intensive Care Units (ICUs). Therefore, this review aims to estimate the effect of Patient and Family-Centered Care Interventions on specific outcomes in adult patients admitted to Intensive Care Units (ICUs).

Methods

We systematically searched four major databases for parallel arm Randomized Controlled Trials (RCTs). The PRISMA framework was used to report our review. We included studies involving adult patients (> 18-years) admitted to ICUs and examined the effects of any type of Patient and Family-Centered Care intervention (PFCC) on outcomes such as depression, anxiety, delirium, and length of hospital stay. Data extraction was performed independently by two authors in Medline, Google Scholar, and ScienceDirect, from inception to July 2024. Random effects model was used to pool the data.

Results

A total of 11 studies were included in our systematic review and meta-analysis, with a combined sample size of 3352 patients (PFCC group, n = 1681; usual care group, n = 1671). A random-effects model revealed a significant reduction in delirium prevalence in the PFCC group, with a pooled Risk Ratio (RR) of 0.54 (95% CI 0.36 to 0.81). However, no statistical significance was found for other outcomes such as depression, length of ICU stay, and anxiety. It is important to note that all the included studies were assessed to have either a high or unclear risk of bias.

Conclusion

PFCC interventions may significantly reduce delirium rates among ICU patients; however, their effects on other outcomes, such as depression, anxiety, and length of stay, were not statistically significant.

背景：以患者和家庭为中心的护理（PFCC）干预措施越来越被认为是解决重症监护病房（icu）患者各种心理健康问题的可行方法。因此，本综述旨在评估以患者和家庭为中心的护理干预对入住重症监护病房（icu）的成年患者特定结局的影响。方法：我们系统地检索了四个主要数据库的平行组随机对照试验（RCTs）。使用PRISMA框架报告我们的审查。我们纳入了icu收治的成年患者（18岁）的研究，并检查了任何类型的以患者和家庭为中心的护理干预（PFCC）对抑郁、焦虑、谵妄和住院时间等结果的影响。数据提取由Medline，谷歌Scholar和ScienceDirect的两位作者独立完成，从成立到2024年7月。采用随机效应模型对数据进行汇总。结果：我们的系统评价和荟萃分析共纳入了11项研究，总样本量为3352例患者(PFCC组，n = 1681；常规护理组，n = 1671)。随机效应模型显示PFCC组谵妄患病率显著降低，合并风险比（RR）为0.54 （95% CI 0.36 ~ 0.81）。然而，其他结果如抑郁、ICU住院时间和焦虑没有统计学意义。值得注意的是，所有纳入的研究都被评估为具有高偏倚风险或不明确的偏倚风险。结论：PFCC干预可显著降低ICU患者谵妄发生率；然而，它们对其他结果的影响，如抑郁、焦虑和住院时间，在统计上并不显著。

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引用次数: 0

Oscillatory ventilation enhances oxygenation and reduces inflammation in an animal model of acute respiratory distress syndrome: an experimental study 在急性呼吸窘迫综合征动物模型中，振荡通气可增强氧合和减少炎症：一项实验研究。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-01 DOI: 10.1016/j.bjane.2024.844576

Luiz Alberto Forgiarini Junior , Luiz Felipe Forgiarini , Arthur de Oliveira Paludo , Rodrigo Mariano , Mikael Marcelo de Moraes , Elaine Aparecida Felix , Cristiano Feijó Andrade

Background

This study aims to compare the use of variable mechanical ventilation with conventional mechanical ventilation in a porcine model of ARDS induced by oleic acid.

Methods

The animals were divided into two groups (n = 6), Conventional Ventilation (CO) and variable ventilation with Bi-Oscillatory PEEP (BiPEEP). ARDS was induced using intravenous oleic acid (0.15 mL.kg⁻¹). After, the animals were evaluated during 180 minutes and, measurements were taken every 30 minutes until the end of the observation period. The animals in the CO group were then ventilated under controlled pressure (Tidal Volume target at 6 mL.kg⁻¹) and 5 cm H₂O PEEP. Variable ventilation was characterized by the oscillation of PEEP from 5 to 10 cm H₂O every 4 respiratory cycles. Ventilatory, hemodynamic parameters, oxidative stress, antioxidant enzymes, Interleukin 8 (IL8) and 17-a (IL17a) were evaluated. Histological samples were collected from the upper and the lower portion of the left lungs and analyzed separately.

Results

BiPEEP improved lung compliance and PaO₂ in comparison to control (p < 0.05). The levels of oxidative stress and antioxidant enzymes showed no significant difference. There was no difference in IL17a between groups. IL8 was significantly increased in the lung base of CO group in relation to BiPEEP group and it was reduced in the apex of BiPEEP group in comparsion to CO group. The BiPEEP group showed less changes in histopathological patterns.

Conclusion

Variable ventilation with bi-oscillatory level of PEEP demonstrated a potential ventilatory strategy for lung protection in an experimental model of ARDS.

背景：本研究旨在比较可变机械通气与传统机械通气在油酸诱导的猪 ARDS 模型中的应用：本研究旨在比较可变机械通气与传统机械通气在油酸诱导的猪 ARDS 模型中的应用：方法：将动物分为两组（n = 6），即常规通气组（CO）和双振荡 PEEP 可变通气组（BiPEEP）。使用静脉注射油酸（0.15 mL.kg-1）诱导 ARDS。之后，在 180 分钟内对动物进行评估，每隔 30 分钟测量一次，直至观察期结束。CO 组动物随后在可控压力（潮气量目标值为 6 mL.kg-1）和 5 cm H2O PEEP 的条件下通气。可变通气的特点是每 4 个呼吸周期 PEEP 从 5 cm H2O 波动到 10 cm H2O。对通气参数、血液动力学参数、氧化应激、抗氧化酶、白细胞介素 8（IL8）和 17-a（IL17a）进行了评估。从左肺上部和下部采集组织学样本并分别进行分析：结果：与对照组相比，BiPEEP 改善了肺顺应性和 PaO2（P < 0.05）。氧化应激和抗氧化酶水平无显著差异。组间 IL17a 无差异。CO 组与 BiPEEP 组相比，IL8 在肺底部明显升高，而 BiPEEP 组与 CO 组相比，IL8 在肺顶部有所降低。BiPEEP 组的组织病理学模式变化较小：结论：在 ARDS 实验模型中，双振荡 PEEP 水平的可变通气显示了一种潜在的肺保护通气策略。

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引用次数: 0

The hidden cost of hypotension: redefining hemodynamic management to improve patient outcomes 低血压的隐性成本：重新定义血流动力学管理以改善患者预后。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-01-01 DOI: 10.1016/j.bjane.2024.844581

Eric B. Lineburger , Deepak K. Tempe , Luiz Guilherme V. da Costa , G. Burkhard Mackensen , Fabio V. Papa , Carlos Galhardo Jr. , Mohamed R. El Tahan , Marcello F. Salgado-Filho , Rodrigo Diaz , André P. Schmidt

引用次数: 0

A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation 大规模输血和大出血方案的全面审查：起源，核心原则和实际实施。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-12-25 DOI: 10.1016/j.bjane.2024.844583

David Silveira Marinho , Denise Menezes Brunetta , Luciana Maria de Barros Carlos , Luany Elvira Mesquita Carvalho , Jessica Silva Miranda

Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called “Damage Control Resuscitation”. This strategy includes four principles: damage control surgery, minimization of crystalloids, permissive hypotension and hemostatic resuscitation. The latter involves the use of antifibrinolytics, correction of preconditions of hemostasis (calcium, pH and temperature) and the early and rapid restoration of intravascular volume with blood products. To enable timely availability and transfusion of blood products, specific actions in different hospital areas need to be synchronized, which are usually organized through Massive Transfusion Protocols or, as they have recently been rebranded, Major Hemorrhage Protocols (MHPs). Although these bundles of actions represent a paradigm change, essential aspects such as their historical evolution, theoretical foundations, terminology and operational elements have yet to be well explored. Considering the wide application range of these tools (emergency departments, interventional radiology, operating rooms and military fields), it is essential to integrate all professionals involved with severe hemorrhage scenarios in the implementation of the aforementioned protocols, from conception to execution and management. This review paper addresses MHP aspects relevant to anesthesiologists, transfusion services and other areas involved with the care of patients with severe bleeding.

直到本世纪初，在选择性手术或失血情况下，出血管理是类似的：使用凝血试验来指导血液制品的订购，在等待这些结果的同时，建议使用晶体药物进行积极的复苏。用这种策略处理的严重出血的高死亡率表明需要一种特殊的复苏计划。因此，建议对这些患者进行修改，以开发一种新的临床方法，称为“损害控制复苏”。该策略包括四个原则：损伤控制手术、晶体最小化、允许性低血压和止血复苏。后者包括使用抗纤溶剂，纠正止血的先决条件（钙、pH值和温度）以及早期和快速恢复血液制品的血管内容量。为了能够及时提供和输血血液制品，需要在不同医院地区采取同步的具体行动，这些行动通常是通过《大规模输血规程》或最近更名为《大出血规程》来组织的。虽然这一系列行动代表了范式的变化，但其历史演变、理论基础、术语和操作要素等基本方面尚未得到充分探讨。考虑到这些工具的广泛应用范围（急诊科、介入放射科、手术室和军事领域），在上述方案的实施中，从概念到执行和管理，整合所有涉及严重出血情景的专业人员是至关重要的。本文综述了与麻醉医师、输血服务和其他涉及重症出血患者护理的领域相关的MHP方面。

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引用次数: 0

Efficacy of Erector Spinae Plane Block (ESPB) in pediatric cardiac surgeries: a systematic review and meta-analysis 直立脊柱平面阻滞（ESPB）在小儿心脏手术中的疗效：一项系统综述和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-11-29 DOI: 10.1016/j.bjane.2024.844579

Verônica Pustrelo Damião , Priscila Pechim Andrade , Leonardo Saraiva Guimarães de Oliveira , Angélica de Fátima Assunção Braga , Vanessa Henriques Carvalho

Background

Erector Spinae Plane Block (ESPB) effectively reduces pain scores for sternotomy in adults. However, evidence is insufficient to assert that the same result occurs in children. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ESPB in pediatric cardiac surgeries.

Methods

Systematic Medline, Embase and Cochrane searches were conducted for studies that compared ESPB versus no block or sham block for pediatric cardiac surgery under sternotomy. The primary outcome was cumulative opioid consumption for up to 48 hours. Statistical analyses were carried out with the use of RStudio version 1.2.1335. Heterogeneity was assessed by Cochran's Q test and I² statistics. Quality assessment and risk of bias assessment complied with Cochrane recommendations.

Results

Five studies, involving 328 patients (3 Randomized Controlled Trials [RCT], and 2 cohorts) were included. Of the 328 patients, 160 (48.7%) underwent ESPB. There were significant reductions in cumulative opioid consumption up to 48 hours after ESPB (SMD -0.68; 95% CI -1.13 – -0.23; p < 0.01). In the following outcomes ESPB failed to show superiority: postoperative nausea and vomiting (OR = 0.56; 95% CI 0.25–1.23; p = 0.54), fever (OR = 0.75; 95% CI 0.24–2.31; p = 0.58), length of intensive care unit stay in hours (MD -2.42; 95% CI -5.47–0.64; p < 0.01] and length of hospital stay in days (MD -0.87; 95% CI -2.69–0.96; p = 0.02). Only one cohort study had a high risk of bias.

Conclusion

ESPB potentially reduces postoperative pain by significant reductions in cumulative opioid consumption up to 48 hours in pediatric cardiac surgery patients.

背景：直立脊柱平面阻滞（ESPB）可有效降低成人胸骨切开术的疼痛评分。然而，证据不足以断言儿童也会出现同样的结果。本系统综述和荟萃分析的目的是评估ESPB在小儿心脏手术中的疗效。方法：系统的Medline， Embase和Cochrane检索了比较ESPB与无阻滞或假阻滞在小儿胸骨切开心脏手术中的研究。主要终点是长达48小时的阿片类药物累积消耗。使用RStudio 1.2.1335版本进行统计分析。异质性采用Cochran’s Q检验和I2统计量进行评估。质量评估和偏倚风险评估符合Cochrane的建议。结果：纳入5项研究，共328例患者（3项随机对照试验[RCT]， 2个队列）。在328例患者中，160例（48.7%）接受了ESPB。ESPB后48小时内，累计阿片类药物消耗显著减少(SMD -0.68；95% ci -1.13 -0.23；P < 0.01)。在以下结果中，ESPB未能显示出优势：术后恶心和呕吐(OR = 0.56；95% ci 0.25-1.23；p = 0.54)，发热(OR = 0.75；95% ci 0.24-2.31；p = 0.58)、重症监护病房住院时间(MD -2.42；95% ci -5.47-0.64；p < 0.01]、住院天数(MD -0.87；95% ci -2.69-0.96； = 0.02页)。只有一项队列研究存在高偏倚风险。结论：ESPB可能通过显著减少儿童心脏手术患者长达48小时的阿片类药物累积消耗来减轻术后疼痛。

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引用次数: 0

Comparative effects of ciprofol and propofol on perioperative outcomes: a systematic review and meta-analysis of randomized controlled trials 环丙酚和异丙酚对围手术期预后的比较影响：随机对照试验的系统回顾和荟萃分析。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-11-26 DOI: 10.1016/j.bjane.2024.844578

Jiazheng Qi , Lingjing Zhang , Fanhua Meng , Xiaoyu Yang , Baoxuan Chen , Lingqi Gao , Xu Zhao , Mengqiang Luo

Background

The ideal anesthetic agents for sedation, considering their respiratory and cardiovascular benefits and other perioperative or postoperative outcomes, are still unclear. This systematic review and meta-analysis aimed to evaluate whether ciprofol has advantages over propofol for sedation, particularly concerning respiratory and cardiovascular outcomes and other relevant perioperative measures.

Methods

We conducted a comprehensive search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and two Chinese databases for randomized controlled trials comparing intravenous ciprofol and propofol for sedation. The primary outcome was the incidence of adverse respiratory events. Secondary outcomes included incidences of injection pain, hypotension, hypertension, bradycardia during surgery, perioperative nausea and vomiting, and postoperative awakening time. A random-effects model was used for more than four studies; otherwise, we employed the random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment.

Results

Intravenous ciprofol resulted in fewer adverse respiratory events than propofol (Risk Ratio [RR = 0.44]; 95% Confidence Interval [95% CI 0.35–0.55], p < 0.001, I² = 45%, low quality). It also showed a lower incidence of injection pain (RR = 0.12; 95% CI 0.08‒0.17, p < 0.001, I² = 36%, low quality), intraoperative hypotension (RR = 0.64; 95% CI 0.52–0.77, p < 0.001, I² = 58%, low quality), and nausea and vomiting than propofol (RR = 0.67; 95% CI 0.49–0.92; p = 0.01, I² = 0%, moderate quality). However, no significant differences were observed for hypertension, bradycardia, and awakening time.

Conclusions

Ciprofol may be more effective than propofol in minimizing perioperative respiratory adverse events and maintaining hemodynamic stability during sedation without prolonging recovery time.

背景：考虑到其呼吸和心血管方面的益处以及其他围手术期或术后结局，理想的镇静麻醉剂仍不清楚。本系统综述和荟萃分析旨在评估环丙酚在镇静方面是否优于异丙酚，特别是在呼吸和心血管结局以及其他相关围手术期措施方面。方法：我们对PubMed、Web of Science、Cochrane Central Register of Controlled Trials和两个中文随机对照试验数据库进行了全面检索，比较静脉注射环丙酚和异丙酚的镇静作用。主要结局是不良呼吸事件的发生率。次要结局包括注射疼痛、低血压、高血压、术中心动过缓、围术期恶心呕吐和术后苏醒时间的发生率。四项以上的研究使用了随机效应模型；否则，我们采用Hartung-Knapp-Sidik-Jonkman平差的随机效应模型。结果：静脉注射环丙酚的不良呼吸事件发生率低于异丙酚(风险比[RR = 0.44]；95%置信区间[95% CI 0.35-0.55], p < 0.001, I2 = 45%，低质量)。注射痛发生率较低(RR = 0.12；95% CI 0.08-0.17, p < 0.001, I2 = 36%，低质量)、术中低血压(RR = 0.64；95% CI 0.52-0.77, p < 0.001, I2 = 58%，低质量)，且恶心呕吐优于异丙酚(RR = 0.67；95% ci 0.49-0.92；p = 0.01,I2 = 0%，质量中等)。然而，在高血压、心动过缓和觉醒时间方面没有观察到显著差异。结论：环丙酚可能比异丙酚更有效地减少围手术期呼吸不良事件和维持镇静期间血流动力学稳定，而不延长恢复时间。

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引用次数: 0

Efficacy of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial 地塞米松或氯硝柳胺作为椎间臂丛神经阻滞的辅助剂对预防肩部手术后反跳痛的疗效：随机临床试验。

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2024-11-24 DOI: 10.1016/j.bjane.2024.844575

Layana Vieira Nobre , Leonardo Henrique Cunha Ferraro , Juscelino Afonso de Oliveira Júnior , Vitória Luiza Locatelli Winkeler , Luis Flávio França Vinhosa Muniz , Hiago Parreão Braga , Plínio da Cunha Leal

Background

Rebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain.

Methods

This was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure.

Results

The incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain.

Conclusion

The administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain.

背景：反跳痛被认为包括镇痛不足引起的痛觉疼痛和区域麻醉引起的痛觉减退。添加辅助剂可预防反跳痛。本研究旨在确定在进行椎间孔阻滞时，在局麻药中添加地塞米松或氯硝西泮能否预防反跳痛：这是一项多中心、前瞻性、平行分组、随机临床试验，研究对象是在超声引导下接受椎间阻滞单次注射 0.375% 布比卡因和肩部手术全身麻醉的患者，他们被随机分配到无添加剂（对照组）、氯尼丁（30 微克）或地塞米松（4 毫克）组。主要结果是反跳痛，其定义为突然发作的疼痛、中度至重度疼痛（VAS ≥7）且口服药物后疼痛无改善，其次是休息时的 VAS 疼痛、所需的解救性镇痛、不良事件或并发症的发生以及组间满意度调查评估。术后2、4、6、12、24和48小时对反跳痛和休息时疼痛进行评估：对照组、地塞米松组和氯尼替丁组的反跳痛发生率分别为 41.2% (95% CI 25.9-57.9)、28.6% (95% CI 16.7-43.3) 和 23.3% (95% CI 12.6-37.6)，组间无统计学差异（P 值 = 0.22）。此外，从麻醉阻滞到首次出现疼痛症状的时间或术后疼痛的严重程度在各组之间没有明显差异：结论：使用地塞米松或氯尼丁作为局部麻醉的硬膜外辅助用药进行单次椎间孔阻滞并不能显著降低反跳痛的发生率。

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引用次数: 0