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已发表论文
地塞米松而非艾氯胺酮可减轻肌间沟神经阻滞后的反弹痛：一项随机析因试验
Authors Yao J , Wang C, Szmuk P, Xu C , Pu S, Lu J, Du D
Received 21 September 2025
Accepted for publication 14 December 2025
Published 24 December 2025 Volume 2025:19 Pages 11511—11523
DOI https://doi.org/10.2147/DDDT.S569175
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Muzammal Hussain
Jiahui Yao,1,* Chengyu Wang,2,* Peter Szmuk,3– 5 Cheng Xu,2 Shaofeng Pu,1 Jie Lu,2 Dongping Du1
1Department of Pain Management, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China; 2Department of Anaesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; 4Children’s Health of Texas, Dallas, TX, USA; 5Outcomes Research Consortium, Cleveland, OH, USA
*These authors contributed equally to this work
Correspondence: Dongping Du, Department of Pain Management, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China, Email dudp@sjtu.edu.cn
Background: Rebound pain following peripheral nerve block resolution is a distressing phenomenon that impairs recovery and commonly arises at night when treatment options are limited.
Objective: To evaluate whether intravenous esketamine and/or dexamethasone, as adjuvants to interscalene ropivacaine block, reduce rebound pain after arthroscopic shoulder surgery.
Design: A patient- and outcome assessor–blinded, randomized, controlled, 2× 2 factorial clinical trial.
Setting: A single tertiary-care academic hospital.
Patients: A total of 160 adult patients undergoing arthroscopic shoulder surgery under general anaesthesia with single-shot interscalene brachial plexus block.
Interventions: Patients were randomized to receive intravenous combinations of esketamine–placebo, placebo–dexamethasone, esketamine–dexamethasone, or placebo–placebo, in addition to ropivacaine block after induction of general anaesthesia and before surgical incision.
Main Outcome Measures: Co-primary outcomes were: (1) the increase in pain score from before to after the ISB resolved; and (2) the incidence of severe rebound pain, defined as numerical rating scale (NRS) pain score ≥ 7.
Results: All 160 patients completed the trial. Rebound pain occurred in 32% of patients, with no interaction between esketamine and dexamethasone. The pain score increased by 6.2 ± 2.5 in the placebo–placebo group versus 4.4 ± 2.5 in the esketamine–dexamethasone group (difference – 1.8; 95% CI – 2.9 to – 0.7; P = 0.002). Dexamethasone significantly reduced the pain score increase compared to placebo (– 1.7; 95% CI – 2.8 to – 0.6; P = 0.003), while esketamine alone did not. Severe rebound pain occurred in 22/80 (27%) of patients receiving esketamine versus 26/80 (32%) without (RR 0.84; 95% CI 0.50 to 1.41; P = 0.459), and in 18/80 (22%) of patients receiving dexamethasone versus 29/80 (36%) without (RR 0.62; 95% CI 0.38 to 0.89; P = 0.016).
Conclusion: Intravenous dexamethasone, but not esketamine (low dose), significantly reduced the incidence and severity of rebound pain following interscalene nerve block.
Trial Registration: Chinese Clinical Trial Registry (ChiCTR2300072416).
Keywords: esketamine, dexamethasone, peripheral nerve block, rebound pain, central sensitization, factorial trial
1Department of Pain Management, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China; 2Department of Anaesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; 4Children’s Health of Texas, Dallas, TX, USA; 5Outcomes Research Consortium, Cleveland, OH, USA
*These authors contributed equally to this work
Correspondence: Dongping Du, Department of Pain Management, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China, Email dudp@sjtu.edu.cn
Background: Rebound pain following peripheral nerve block resolution is a distressing phenomenon that impairs recovery and commonly arises at night when treatment options are limited.
Objective: To evaluate whether intravenous esketamine and/or dexamethasone, as adjuvants to interscalene ropivacaine block, reduce rebound pain after arthroscopic shoulder surgery.
Design: A patient- and outcome assessor–blinded, randomized, controlled, 2× 2 factorial clinical trial.
Setting: A single tertiary-care academic hospital.
Patients: A total of 160 adult patients undergoing arthroscopic shoulder surgery under general anaesthesia with single-shot interscalene brachial plexus block.
Interventions: Patients were randomized to receive intravenous combinations of esketamine–placebo, placebo–dexamethasone, esketamine–dexamethasone, or placebo–placebo, in addition to ropivacaine block after induction of general anaesthesia and before surgical incision.
Main Outcome Measures: Co-primary outcomes were: (1) the increase in pain score from before to after the ISB resolved; and (2) the incidence of severe rebound pain, defined as numerical rating scale (NRS) pain score ≥ 7.
Results: All 160 patients completed the trial. Rebound pain occurred in 32% of patients, with no interaction between esketamine and dexamethasone. The pain score increased by 6.2 ± 2.5 in the placebo–placebo group versus 4.4 ± 2.5 in the esketamine–dexamethasone group (difference – 1.8; 95% CI – 2.9 to – 0.7; P = 0.002). Dexamethasone significantly reduced the pain score increase compared to placebo (– 1.7; 95% CI – 2.8 to – 0.6; P = 0.003), while esketamine alone did not. Severe rebound pain occurred in 22/80 (27%) of patients receiving esketamine versus 26/80 (32%) without (RR 0.84; 95% CI 0.50 to 1.41; P = 0.459), and in 18/80 (22%) of patients receiving dexamethasone versus 29/80 (36%) without (RR 0.62; 95% CI 0.38 to 0.89; P = 0.016).
Conclusion: Intravenous dexamethasone, but not esketamine (low dose), significantly reduced the incidence and severity of rebound pain following interscalene nerve block.
Trial Registration: Chinese Clinical Trial Registry (ChiCTR2300072416).
Keywords: esketamine, dexamethasone, peripheral nerve block, rebound pain, central sensitization, factorial trial