Pain medicine (Malden, Mass.) · 2026
Perineural or intravenous dexamethasone for adductor canal and iPACK blocks in total knee arthroplasty: A randomised trial.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Reysner Tomasz, Bartkowska-Śniatkowska Alicja, Rosada-Kurasińska Jowita, Wieczorowska-Tobis Katarzyna, Daroszewski Przemysław, Reysner Malgorzata
Аннотация
INTRODUCTION: Total knee arthroplasty causes substantial postoperative pain. Combined adductor canal and interspace block between the popliteal artery and posterior knee capsule (iPACK) provides motor-sparing analgesia, but its duration is limited. We compared perineural and intravenous dexamethasone as adjuncts to these blocks in older patients undergoing primary total knee arthroplasty.
METHODS: In this prospective, randomised, quadruple-blind, parallel-group trial, 90 patients aged 65-100 years were allocated equally to receive adductor canal and iPACK blocks with ropivacaine plus perineural dexamethasone 4 mg in total (2 mg per block), intravenous dexamethasone 4 mg, or placebo. The primary outcome was time to first rescue opioid analgesia within 48 h. Secondary outcomes included opioid consumption, pain scores, inflammatory markers, blood glucose, quadriceps strength, and neurological safety.
RESULTS: Time to first rescue opioid analgesia differed between groups (log-rank p < 0.001). Median time (95% CI) was 4.5 (4.5-5.5) h with placebo, 13.9 (12.5-14.7) h with intravenous dexamethasone, and 18.5 (16.5 to not reached) h with perineural dexamethasone. The proportions remaining opioid-free at 48 h were 0%, 23.3%, and 36.7%, respectively. Opioid consumption and pain scores were lower with both dexamethasone routes than with placebo; perineural administration resulted in the lowest opioid consumption and lower pain scores than intravenous administration at later timepoints. Perineural dexamethasone was associated with lower postoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, whereas intravenous dexamethasone was associated with higher blood glucose. No motor weakness or nerve injury occurred.
DISCUSSION: Perineural dexamethasone prolonged analgesia and reduced opioid requirements more than intravenous dexamethasone, without neurological or motor impairment. The inflammatory-marker findings were exploratory and do not establish independent clinical benefit.
METHODS: In this prospective, randomised, quadruple-blind, parallel-group trial, 90 patients aged 65-100 years were allocated equally to receive adductor canal and iPACK blocks with ropivacaine plus perineural dexamethasone 4 mg in total (2 mg per block), intravenous dexamethasone 4 mg, or placebo. The primary outcome was time to first rescue opioid analgesia within 48 h. Secondary outcomes included opioid consumption, pain scores, inflammatory markers, blood glucose, quadriceps strength, and neurological safety.
RESULTS: Time to first rescue opioid analgesia differed between groups (log-rank p < 0.001). Median time (95% CI) was 4.5 (4.5-5.5) h with placebo, 13.9 (12.5-14.7) h with intravenous dexamethasone, and 18.5 (16.5 to not reached) h with perineural dexamethasone. The proportions remaining opioid-free at 48 h were 0%, 23.3%, and 36.7%, respectively. Opioid consumption and pain scores were lower with both dexamethasone routes than with placebo; perineural administration resulted in the lowest opioid consumption and lower pain scores than intravenous administration at later timepoints. Perineural dexamethasone was associated with lower postoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, whereas intravenous dexamethasone was associated with higher blood glucose. No motor weakness or nerve injury occurred.
DISCUSSION: Perineural dexamethasone prolonged analgesia and reduced opioid requirements more than intravenous dexamethasone, without neurological or motor impairment. The inflammatory-marker findings were exploratory and do not establish independent clinical benefit.