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Glucocorticoide als Adjuvanz in der peripheren Regionalanästhesie

Unterwegs zum „Heiligen Gral der perineuralen Analgesie“?!

Glucocorticoids as an adjunct in peripheral regional anesthesia

Move to the “Holy Grail of perineural analgesia” ?!

  • Regionalanästhesie
  • Published:
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Zusammenfassung

Hintergrund

Der Stellenwert von Dexamethason als Adjuvans in der peripheren Regionalanästhesie ist aktuell unklar.

Fragestellung

Diese Übersichtsarbeit gibt eine komprimierte Darstellung der gegenwärtigen Erkenntnisse zum Thema „Dexamethason als Adjuvans in der peripheren Regionalanästhesie“. Insbesondere wird der Vergleich mit einer systemischen Applikation diskutiert.

Ergebnisse

Dexamethason verlängert sowohl bei systemischer als auch bei perineuraler Applikation die motorische und sensible Blockadedauer bei peripheren Nervenblockaden. Über potenzielle neurotoxische Nebenwirkungen können aufgrund der geringen Zahl an untersuchten Patienten bisher keine eindeutigen Aussagen gemacht werden.

Schlussfolgerungen

Aufgrund der derzeitigen Studienlage favorisieren die Autoren eine systemische Gabe von Dexamethason als Lokalanästhetika-Adjuvans, da hierbei die potenziellen Nebenwirkungen besser untersucht sind. Unabhängig von einer perineuralen oder intravenösen Gabe verlängern Glucocorticoide die Blockadedauer peripherer Regionalanästhesien. Dexamethason könnte eine sinnvolle Ergänzung zur Verlängerung peripherer Single-Shot-Regionalanästhesieverfahren darstellen.

Abstract

Background

The role of dexamethasone as an adjunct in peripheral nerve blockades is still unclear.

Objectives

This article reviews the actual knowledge and scientific evidence for dexamethasone as an adjunct in peripheral regional anesthesia. Moreover, it discusses the benefits of the systemic versus the perineural mode of application.

Results

Dexamethasone prolongs sensible as well as motor blockades in peripheral nerve blocks when applied intravenously or perineurally. Regarding potentially local neurotoxicity, published patient data are not sufficient for final conclusions.

Conclusions

After reviewing the actual literature, the authors prefer a systemic application mode (intravenously) over a perineural route of administration of dexamethasone as an adjunct for peripheral nerve blocks. This is due to the better understanding of potential side effects of the drug when applied intravenously. Dexamethasone might be a useful drug adjunct to prolong peripheral single shot nerve blocks.

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Literatur

  1. Knight JB, Schott NJ, Kentor ML, Williams BA (2015) Neurotoxicity of common peripheral nerve block adjuvants. Curr Opin Anaesthesiol 28(5):598–604

    Article  CAS  PubMed  Google Scholar 

  2. Abdallah FW, Halpern SH, Aoyama K, Brull R (2015) Will the real benefits of single-shot Interscalene block please stand up? a systematic review and meta-analysis. Anesth Analg 120(5):1114–1129

    Article  PubMed  Google Scholar 

  3. Williams BA, Schott NJ, Mangione MP, Ibinson JW (2014) Perineural dexamethasone and multimodal perineural analgesia: how much is too much? Anesth Analg 118:912–914

    Article  PubMed  Google Scholar 

  4. Albrecht E, Kern C, Kirkham KR (2015) A systematic review and meta-analysis of perineural dexamethasone for peripheral nerve blocks. Anaesthesia 70:71–83

    Article  CAS  PubMed  Google Scholar 

  5. Choi S, Rodseth R, McCartney CJL (2014) Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials. Br J Anaesth 112:427–439

    Article  CAS  PubMed  Google Scholar 

  6. Williams BA, Hough KA, Tsui BYK, Ibinson JW, Gold MS, Gebhart GF (2011) Neurotoxicity of Adjuvants used in Perineural anesthesia and analgesia in comparison with Ropivacaine. Reg Anesth Pain Med 36:225–230

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Candido KD, Knezevic NN (2011) All adjuvants to local anesthetics were not created equal: animal data evaluating neurotoxicity, thermal hyperalgesia, and relevance to human application. Reg Anesth Pain Med 36:211–212

    Article  PubMed  Google Scholar 

  8. Dani C, Vestri V, Bertini G, Pratesi S, Rubaltelli FF (2007) Toxicity of corticosteroids and catecholamines for mice neuronal cell cultures: role of preservatives. J Matern Fetal Neonatal Med 20:325–333

    Article  CAS  PubMed  Google Scholar 

  9. Kirksey MA, Haskins SC, Cheng J, Liu SS (2015) Local anesthetic peripheral nerve block Adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One 10(9):e0137312

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, Watcha M, Chung F, Angus S, Apfel CC, Bergese SD, Candiotti KA, Chan MT, Davis PJ, Hooper VD, Lagoo-Deenadayalan S, Myles P, Nezat G, Philip BK, Tramèr MR (2014) Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 118:85–113 (Society for Ambulatory Anesthesia)

    Article  PubMed  Google Scholar 

  11. Wiesmann T, Kranke P, Eberhart L (2015) Postoperative nausea and vomiting – a narrative review of pathophysiology, pharmacotherapy and clinical management strategies. Expert Opin Pharmacother 16:1069–1077

    Article  CAS  PubMed  Google Scholar 

  12. Huynh TM, Marret E, Bonnet F (2015) Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol 32:751–758

    Article  CAS  PubMed  Google Scholar 

  13. Rahangdale R, Kendall MC, McCarthy RJ, Tureanu L, Doty R, Weingart A, De Oliveira GS (2014) The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: a randomized, double-blind, placebo-controlled study. Anesth Analg 118:1113–1119

    Article  CAS  PubMed  Google Scholar 

  14. Woo JH, Kim YJ, Kim DY, Cho S (2015) Dose-dependency of dexamethasone on the analgesic effect of interscalene block for arthroscopic shoulder surgery using ropivacaine 0.5 %: a randomised controlled trial. Eur J Anaesthesiol 32:650–655

    Article  CAS  PubMed  Google Scholar 

  15. Liu J, Richman KA, Grodofsky SR, Bhatt S, Huffman GR, Kelly JD, Glaser DL, Elkassabany N (2015) Is there a dose response of dexamethasone as adjuvant for supraclavicular brachial plexus nerve block? A prospective randomized double-blinded clinical study. J Clin Anesth 27:237–242

    Article  CAS  PubMed  Google Scholar 

  16. Desmet M, Vanneste B, Reynvoet M, Van Cauwelaert J, Verhelst L, Pottel H, Missant C, Van de Velde M (2015) A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery. Anaesthesia 70:1180–1185

    Article  CAS  PubMed  Google Scholar 

  17. Desmet M, Braems H, Reynvoet M, Plasschaert S, Van Cauwelaert J, Pottel H, Carlier S, Missant C, Van de Velde M (2013) I. V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br J Anaesth 111:445–452

    Article  CAS  PubMed  Google Scholar 

  18. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588

    Article  PubMed  Google Scholar 

  19. Lunn TH, Kehlet H (2013) Perioperative glucocorticoids in hip and knee surgery – benefit vs. harm? A review of randomized clinical trials. Acta Anaesthesiol Scand 57:823–834

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Anästhesie und Intensivtherapie, Universitätsklinik Gießen und Marburg, Baldingerstraße, 35033, Marburg, Deutschland

    T. Wiesmann & T. Steinfeldt Prof. Dr.

  2. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg, Deutschland

    T. Volk Prof. Dr.

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  1. T. Wiesmann
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  2. T. Volk Prof. Dr.
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  3. T. Steinfeldt Prof. Dr.
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Correspondence to T. Wiesmann.

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Interessenkonflikt

T. Wiesmann, T. Volk und T. Steinfeldt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Wiesmann, T., Volk, T. & Steinfeldt, T. Glucocorticoide als Adjuvanz in der peripheren Regionalanästhesie. Anaesthesist 65, 295–298 (2016). https://doi.org/10.1007/s00101-016-0143-x

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  • DOI: https://doi.org/10.1007/s00101-016-0143-x

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