静脉注射地塞米松对小儿踝关节手术腘窝神经阻滞后镇痛持续时间的影响：一项随机、三盲临床试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：李彩蝶 编辑：赵游霄 审校：曹莹
儿童足踝手术后有效的疼痛控制仍然具有挑战性。腘窝神经阻滞应用广泛，但受限于作用持续时间较短。全身性地塞米松可能延长镇痛时间，然而在儿童区域麻醉中的相关证据仍然匮乏。
评估在接受踝关节或足部手术的儿童中，单次腘窝神经阻滞前给予两种静脉注射地塞米松剂量（0.1 mg/kg 和 0.2 mg/kg）的镇痛效果和安全性。在这项随机、三盲临床试验中，90 名儿科患者被分配在腘窝神经阻滞前接受安慰剂、0.1 mg/kg 或 0.2 mg/kg 地塞米松静脉注射。主要结局是首次需要阿片类药物的时间。次要结局包括阿片类药物总消耗量、FLACC 疼痛评分、炎症标志物（NLR、PLR）、血糖以及运动功能恢复时间。
与安慰剂组相比，两个地塞米松组的无阿片类药物间隔时间显著更长（分别为 12.3±2.4 小时和 13.7±2.6 小时，安慰剂组为 7.5±2.2 小时；p<0.0001）。0.2 mg/kg 组的阿片类药物消耗量最低（p=0.0292）。地塞米松组的疼痛评分和炎症标志物始终较低。然而，血糖水平呈剂量依赖性升高，0.2 mg/kg 组的血糖值最高。使用地塞米松还会延迟运动功能恢复。
静脉注射地塞米松能有效延长儿科足踝手术后的镇痛时间并减少阿片类药物的需求。虽然 0.2 mg/kg 剂量能带来最大益处，但 0.1 mg/kg 剂量可能在疗效和代谢安全性之间取得最佳平衡。
原始文献：
Reysner T, Ciftci B, Pietraszek P, Purat T, Shadi M, Musielak B, Idzior M, Daroszewski P, Reysner M. Effect of intravenous dexamethasone on duration of analgesia following popliteal nerve block in pediatric ankle surgery: A randomized, triple-blinded clinical trial. J Clin Anesth. 2025 Dec 5;109:112094.
英文原文：
Effect of intravenous dexamethasone on duration of analgesia following popliteal nerve block in pediatric ankle surgery: A randomized, triple-blinded clinical trial
Abstract
Background
Effective postoperative pain control in pediatric foot and ankle surgery remains challenging. Popliteal nerve blocks are widely used but limited by their short duration. Systemic dexamethasone may prolong analgesia, yet evidence in pediatric regional anesthesia remains sparse.
Objective
To assess the analgesic efficacy and safety of two intravenous dexamethasone doses (0.1 mg/kg and 0.2 mg/kg) administered before a single-shot popliteal nerve block in children undergoing ankle or foot surgery.
Methods
In this randomized, triple-blinded clinical trial, 90 pediatric patients were allocated to receive either placebo, 0.1 mg/kg, or 0.2 mg/kg dexamethasone intravenously prior to popliteal nerve block. The primary outcome was time to first opioid requirement. Secondary outcomes included total opioid consumption, FLACC pain scores, inflammatory markers (NLR, PLR), blood glucose, and time to motor recovery.
Results
Both dexamethasone groups had significantly longer opioid-free intervals compared to placebo (12.3 ± 2.4 h and 13.7 ± 2.6 h vs. 7.5 ± 2.2 h; p < 0.0001). Opioid consumption was lowest in the 0.2 mg/kg group (p = 0.0292). Pain scores and inflammatory markers were consistently lower in dexamethasone groups. However, blood glucose levels increased dose-dependently, with the highest values in the 0.2 mg/kg group. Motor recovery was also delayed with dexamethasone use.
Conclusion
Intravenous dexamethasone effectively prolongs analgesia and reduces opioid requirements after pediatric foot and ankle surgery. While 0.2 mg/kg provides maximal benefit, 0.1 mg/kg may offer an optimal balance between efficacy and metabolic safety.
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