Otimização da Analgesia Pós-operatória na Artroplastia Total do Joelho: Ensaio Aleatório Controlado sobre a Eficácia da Dexametasona Perineural Com Bloco de Canal iPACK e Addutor

O que aconteceu

To assess the effect of perineural dexamethasone on analgesia duration and opioid consumption when used as an adjuvant to the iPACK (infiltration between the popliteal artery and capsule of the knee) block and adductor canal block in patients undergoing total knee arthroplasty. In this double-blind, randomized controlled trial, 60 patients aged 65 years or older undergoing total knee arthroplasty under spinal anesthesia were assigned to one of 2 groups. The control group received iPACK and adductor canal block with 0.2% ropivacaine alone, while the Dexamethasone group received the same blocks with the addition of perineural dexamethasone. The primary outcome was time to first opioid rescue analgesia. Secondary outcomes included total opioid consumption over 48 hours, postoperative pain scores at defined time points, quadriceps muscle strength, and adverse effects, including neurological complications and hyperglycemia. Perineural dexamethasone enhanced the duration and quality of postoperative analgesia without compromising motor function. Its inclusion in regional analgesia protocols for total knee arthroplasty may contribute to improved recovery and reduced opioid use.

Trecho mantido em inglês: a tradução automática não passou na conferência de números.

O que encontraram

Os pacientes que receberam dexametasona apresentaram uma duração significativamente mais longa de analgesia (15,9±1,2 h vs. 8,8±1,6 h), menor consumo total de opióides ao longo de 48 horas (1,2±1,3 mg vs. 2,3±1,4 mg de morfina equivalente), e menos pacientes necessitaram de opióides (20% vs. 50%). Os escores de dor foram significativamente menores às 8 e 12 horas de pós-operatório. Não foram observadas diferenças na função motora ou nas taxas de eventos adversos.