Tayfun Et, Betul Basaran, Aysegul Bilge, Rafet Yarımoğlu, Muhammet Korkusuz, İbrahim Tülüce
{"title":"肩部手术椎间臂丛阻滞术后的反跳痛：不同多模式镇痛方案效果的随机临床试验。","authors":"Tayfun Et, Betul Basaran, Aysegul Bilge, Rafet Yarımoğlu, Muhammet Korkusuz, İbrahim Tülüce","doi":"10.5144/0256-4947.2023.339","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Rebound pain is characterized by sudden, significant acute postoperative pain occurring after the resolution of inter-scalene block (ISB); it affects the quality of recovery postoperatively. Dexamethasone increases ISB resolution time and decreases opioid consumption and the incidence of rebound pain.</p><p><strong>Objective: </strong>Evaluate whether multimodal analgesia including intravenous dexamethasone administration with preoperative ISB reduces the incidence of rebound pain.</p><p><strong>Design: </strong>Prospective, randomized, controlled trial.</p><p><strong>Setting: </strong>Tertiary university hospital.</p><p><strong>Sample size: </strong>60 patients.</p><p><strong>Patients and methods: </strong>Patients who underwent shoulder surgery under general anesthesia were assigned randomly to two different multimodal analgesia protocols. Thirty patients received 5 mg IV dexamethasone with non-steroid, paracetamol, and ISB with 15 mL 0.5% bupivacaine, while the control patients received the same regimen and ISB with 15 mL 0.5% bupivacaine without dexamethasone. Postoperative opioids were given to any patient on demand.</p><p><strong>Main outcomes measures: </strong>Effect of IV dexamethasone on pain score and incidence of rebound pain after ISB resolution and postoperative opioid consumption at 0-48 hours, numerical pain rating scale (NPRS) scores, sleep scale scores, and quality of recovery-15 scores (QoR-15).</p><p><strong>Results: </strong>The incidence of rebound pain was lower in the dexamethasone group than in the control group (73.3% and 30%, respectively, <i>P</i>=.001). NPRS scores after ISB resolution were lower in the dexamethasone group (5 ([4-7]), 8 ([5.75-8]), <i>P</i><.001, respectively). Those who received IV dexamethasone had less sleep disturbances (<i>P</i><.001) and higher QoR-15 on day 1 (<i>P</i><.001) and day 7 (<i>P</i>=.020) postoperatively.</p><p><strong>Conclusions: </strong>IV dexamethasone added to the ISB block resulted in a lower incidence of rebound pain. In addition, better results were obtained in postoperative sleep quality and QoR-15.</p><p><strong>Limitations: </strong>Single-center study.</p>","PeriodicalId":93875,"journal":{"name":"Annals of Saudi medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182429/pdf/","citationCount":"0","resultStr":"{\"title\":\"Rebound pain after interscalene brachial plexus block for shoulder surgery: a randomized clinical trial of the effect of different multimodal analgesia regimens.\",\"authors\":\"Tayfun Et, Betul Basaran, Aysegul Bilge, Rafet Yarımoğlu, Muhammet Korkusuz, İbrahim Tülüce\",\"doi\":\"10.5144/0256-4947.2023.339\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Rebound pain is characterized by sudden, significant acute postoperative pain occurring after the resolution of inter-scalene block (ISB); it affects the quality of recovery postoperatively. Dexamethasone increases ISB resolution time and decreases opioid consumption and the incidence of rebound pain.</p><p><strong>Objective: </strong>Evaluate whether multimodal analgesia including intravenous dexamethasone administration with preoperative ISB reduces the incidence of rebound pain.</p><p><strong>Design: </strong>Prospective, randomized, controlled trial.</p><p><strong>Setting: </strong>Tertiary university hospital.</p><p><strong>Sample size: </strong>60 patients.</p><p><strong>Patients and methods: </strong>Patients who underwent shoulder surgery under general anesthesia were assigned randomly to two different multimodal analgesia protocols. Thirty patients received 5 mg IV dexamethasone with non-steroid, paracetamol, and ISB with 15 mL 0.5% bupivacaine, while the control patients received the same regimen and ISB with 15 mL 0.5% bupivacaine without dexamethasone. Postoperative opioids were given to any patient on demand.</p><p><strong>Main outcomes measures: </strong>Effect of IV dexamethasone on pain score and incidence of rebound pain after ISB resolution and postoperative opioid consumption at 0-48 hours, numerical pain rating scale (NPRS) scores, sleep scale scores, and quality of recovery-15 scores (QoR-15).</p><p><strong>Results: </strong>The incidence of rebound pain was lower in the dexamethasone group than in the control group (73.3% and 30%, respectively, <i>P</i>=.001). NPRS scores after ISB resolution were lower in the dexamethasone group (5 ([4-7]), 8 ([5.75-8]), <i>P</i><.001, respectively). Those who received IV dexamethasone had less sleep disturbances (<i>P</i><.001) and higher QoR-15 on day 1 (<i>P</i><.001) and day 7 (<i>P</i>=.020) postoperatively.</p><p><strong>Conclusions: </strong>IV dexamethasone added to the ISB block resulted in a lower incidence of rebound pain. In addition, better results were obtained in postoperative sleep quality and QoR-15.</p><p><strong>Limitations: </strong>Single-center study.</p>\",\"PeriodicalId\":93875,\"journal\":{\"name\":\"Annals of Saudi medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11182429/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Saudi medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5144/0256-4947.2023.339\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/12/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5144/0256-4947.2023.339","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/7 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
Rebound pain after interscalene brachial plexus block for shoulder surgery: a randomized clinical trial of the effect of different multimodal analgesia regimens.
Background: Rebound pain is characterized by sudden, significant acute postoperative pain occurring after the resolution of inter-scalene block (ISB); it affects the quality of recovery postoperatively. Dexamethasone increases ISB resolution time and decreases opioid consumption and the incidence of rebound pain.
Objective: Evaluate whether multimodal analgesia including intravenous dexamethasone administration with preoperative ISB reduces the incidence of rebound pain.
Patients and methods: Patients who underwent shoulder surgery under general anesthesia were assigned randomly to two different multimodal analgesia protocols. Thirty patients received 5 mg IV dexamethasone with non-steroid, paracetamol, and ISB with 15 mL 0.5% bupivacaine, while the control patients received the same regimen and ISB with 15 mL 0.5% bupivacaine without dexamethasone. Postoperative opioids were given to any patient on demand.
Main outcomes measures: Effect of IV dexamethasone on pain score and incidence of rebound pain after ISB resolution and postoperative opioid consumption at 0-48 hours, numerical pain rating scale (NPRS) scores, sleep scale scores, and quality of recovery-15 scores (QoR-15).
Results: The incidence of rebound pain was lower in the dexamethasone group than in the control group (73.3% and 30%, respectively, P=.001). NPRS scores after ISB resolution were lower in the dexamethasone group (5 ([4-7]), 8 ([5.75-8]), P<.001, respectively). Those who received IV dexamethasone had less sleep disturbances (P<.001) and higher QoR-15 on day 1 (P<.001) and day 7 (P=.020) postoperatively.
Conclusions: IV dexamethasone added to the ISB block resulted in a lower incidence of rebound pain. In addition, better results were obtained in postoperative sleep quality and QoR-15.
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