小柯机器人

丹麦哥本哈根大学Ole Mathiesen团队研究了地塞米松辅助镇痛对全膝关节置换术后多模式疼痛治疗的影响。2022年1月4日出版的《英国医学杂志》发表了这项成果。

为了探讨全膝关节置换术后静脉注射一剂和两剂地塞米松的效果，2018年9月至2020年3月，研究组在丹麦的5家医院进行了一项随机、双盲、安慰剂对照试验，随访90天。共有485名成人参与者接受全膝关节置换术。将参与者随机分组，分别接受DX1（第1剂地塞米松，第2剂安慰剂）、DX2（第1剂地塞米松，第2剂地塞米松）和DX3（第1剂安慰剂，第2剂安慰剂）治疗。

术前和术后24小时进行干预。参与者、研究者和结果评估者互不知情。所有参与者均接受扑热息痛、布洛芬和局部渗透镇痛。主要观察指标为术后0-48小时静脉注射吗啡总量。统计显著性的多重校正阈值为P<0.017，最小显著差异为10 mg吗啡。次要结局包括术后疼痛。

485名参与者被随机分配，其中DX1组161例，DX2组162例，安慰剂组162例。472名参与者（97.3%）的数据被纳入主要结局分析。DX1组0-48小时吗啡的中位用量为37.9 mg，DX2组为35.0 mg，安慰剂组为43.0 mg。DX1组和DX2组间的差异不显著，DX1组和DX2组显著低于安慰剂组，差异具有统计学意义。术后24小时使用一剂地塞米松、术后48小时使用两剂地塞米松可有效减轻疼痛。

研究结果表明，两剂地塞米松可有效减少全膝关节置换术后48小时内吗啡的用量，并减轻术后疼痛。

附：英文原文

Title: Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Author: Kasper Smidt Gasbjerg, Daniel Hgi-Pedersen, Troels Haxholdt Lunn, Christina Cleveland Laursen, Majken Holmqvist, Louise rts Vinstrup, Mette Ammitzboell, Karina Jakobsen, Mette Skov Jensen, Marie Jhnk Pallesen, Jens Bagger, Peter Lindholm, Niels Anker Pedersen, Henrik Morville Schrder, Martin Lindberg-Larsen, Anders Kehlet Nrskov, Kasper Hjgaard Thybo, Stig Brorson, Sren Overgaard, Janus Christian Jakobsen, Ole Mathiesen

Issue&Volume: 2022/01/04

Abstract:

Objective To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty.

Design Randomised, blinded, placebo controlled trial with follow-up at 90 days.

Setting Five Danish hospitals, September 2018 to March 2020.

Participants 485 adult participants undergoing total knee arthroplasty.

Intervention A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia.

Main outcome measures The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain.

Results 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: 2.7 mg (98.3% confidence interval 9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone.

Conclusion Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain.

DOI: 10.1136/bmj-2021-067325

Source: https://www.bmj.com/content/376/bmj-2021-067325

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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