观察和比较静脉注射或神经周围注射地塞米松对肩袖损伤患者神经阻滞后爆发痛的影响，为优化镇痛策略提供临床依据。

选择2024年4月~ 2024年10月因肩袖损伤拟行择期肩袖修补术的患者共100例，采用随机数字表法分为2组：静脉注射地塞米松组（Ⅳ组）50例，神经周围注射地塞米松组（PN组）50例。所有患者术前30 min接受肌间沟入路臂丛神经阻滞。Ⅳ组患者术前使用0.25%罗哌卡因20 ml行臂丛神经阻滞，随即静脉注射地塞米松1 ml（5 mg）；PN组患者术前使用0.25%罗哌卡因复合地塞米松5 mg配制成20 ml，随即静脉注射生理盐水1 ml。患者入室后均接受相同的麻醉诱导和麻醉维持方案。收集2组患者一般资料情况，神经阻滞后爆发痛发生率、严重程度和持续时间，臂丛神经阻滞持续时间，苏醒后、术后6、12、24、48 h和30 d的NRS评分，首次氨酚曲马多需求时间，术后48 h氨酚曲马多总用量，术后当晚睡眠障碍发生率，住院时间，术后不良反应。

2组患者的一般资料情况差异均无统计学意义（P均>0 .05）。与Ⅳ组比较，PN组患者的爆发痛发生率、术后12、24 h静息时及活动后NRS评分、术后当晚睡眠障碍发生率均较低，差异均具有统计学意义（P均<0.05）。与Ⅳ组比较，PN组患者臂丛神经阻滞持续时间更长，首次使用氨酚曲马多需求时间更迟，术后48 h氨酚曲马多总量更少，差异均具有统计学意义（P均<0.05）。

对经肌间沟入路臂丛神经阻滞的肩袖修补术患者，神经周围注射地塞米松可显著降低术后疼痛程度和爆发痛的发生，减少阿片类的药物用量，推迟使用阿片类药物时间，改善术后睡眠质量。

To compare the incidence of rebound pain, postoperative analgesic effect, and opioid consumption after interscalene brachial plexus block (ISBPB) with intravenous or perineural dexamethasone in patients with rotator cuff injuries.

One hundred patients were randomly assigned into two groups according to the random number table method, to receive either intravenous dexamethasone (Ⅳ group, n=50) or perineural dexamethasone (PN group, n=50) during ISBPB. All the participants underwent ISBPB about 30 min before surgery. Patients in the Ⅳ group were administered with 20 ml ropivacaine at a concentration of 0.25% for ISBPB, and then injected with dexamethasone 1 ml (5 mg) intravenously. Patients in the PN group were administered with 20 ml mixture of ropivacaine 0.25% plus dexamethasone 5 mg, and then injected with 1 ml normal saline. The protocols of anesthesia induction and maintenance were exactly the same for the two groups. Demographic data and surgery-related data of the patients were collected. The observations in the two groups were as follows: the incidence of rebound pain, as well as its intensity and duration; the duration of brachial plexus block; the NRS pain scores at PACU and 6 h, 12 h, 24 h, 48 h, and 30 d postoperatively, including at rest and after movement; the initial time of requiring tramadol, and the total consumption of this rescue drug; the occurrence of sleep disturbance at the current night; the hospital stay and adverse reactions.

There were no significant differences between the two groups in demographic data and surgery-related data (P>0.05). Patients in the PN group had a lower incidence of rebound pain, lower NRS values at 12 h and 24 h postoperatively, and a lower incidence of sleep disturbance compared with those of the Ⅳ group (P<0.05). Patients in the PN group exhibited a longer duration of ISBPB and longer time to first tramadol requirement, as well as lower total consumption of tramadol within 48 hours compared with those of the Ⅳ group (P<0.05).

In rotator cuff repair surgery, compared with intravenous dexamethasone, preoperative ISBPB combined with perineural dexamethasone is able to reduce the incidence of rebound pain, the extent of postoperative pain, and the total consumption of analgesic within two days, delay the first time to require rescuing analgesic, and reduce the incidence of sleep disturbance.