Dahan T H, Fortin L, Pelletier M, Petit M, Vadeboncoeur R, Suissa S
Division of Medicine and Physiatry, Centre Hospitalier de l'Université de Montreal, University of Montreal, Quebec, Canada.
J Rheumatol. 2000 Jun;27(6):1464-9.
To determine whether the pain, contracture, and disability associated with idiopathic frozen shoulder are diminished by a series of 3 indirect bupivacaine suprascapular nerve blocks delivered in an ambulatory care clinic.
A double blind randomized controlled trial of patients referred by primary care and specialty clinics in Montreal to an ambulatory tertiary care academic facility. Patients and controls underwent a series of 3 indirect suprascapular nerve blocks at 7 day intervals using either 10 c.c. bupivacaine 0.5 (Marcaine) in the treatment group or 10 c.c. of physiological saline in controls. Subjects in both groups were taught a program of shoulder range of motion exercises to be done at home. The primary outcome measure was the McGill-Melzack Pain Questionnaire (MPQ) short form at 1 month post-randomization (2 weeks after last injection). The secondary outcome measures were disability measured by the simple shoulder test and glenohumeral joint contracture measured by shoulder range of motion measurements.
Thirty-four subjects were randomized from 58 screened. Average age of subjects was 52 years. Mean duration of pain prior to randomization was one year. Dropout rate was 11% in the treatment group, 30% in the placebo group. A 64% reduction in pain in the treatment group versus 13% in the placebo group was observed at one month as measured by the MPQ multidimensional pain descriptors score (p = 0.03). A nonsignificant 15.8% improvement in shoulder function in the treatment group versus 4% in the placebo group (p = 0.24) was also noted. No improvement in shoulder range of movement was noted. No side effects other than transient vagal symptoms and local tenderness at the injection site were reported.
The use of bupivacaine suprascapular nerve blocks was effective in reducing the pain of frozen shoulder at one month. Clinical studies with a larger number of subjects and a longer study period will help determine the duration and nature of the effect of bupivacaine suprascapular nerve blocks in treating the pain, disability, and glenohumeral joint contracture of frozen shoulder.
确定在门诊护理诊所进行的一系列3次间接布比卡因肩胛上神经阻滞能否减轻与特发性肩周炎相关的疼痛、挛缩和功能障碍。
一项双盲随机对照试验，研究对象为蒙特利尔初级保健和专科诊所转诊至门诊三级护理学术机构的患者。患者和对照组每隔7天接受一系列3次间接肩胛上神经阻滞，治疗组使用10毫升0.5%布比卡因（耐乐品），对照组使用10毫升生理盐水。两组受试者均学习了一套在家中进行的肩关节活动度锻炼方案。主要结局指标是随机分组后1个月（最后一次注射后2周）的麦吉尔-梅尔扎克疼痛问卷（MPQ）简表。次要结局指标包括通过简单肩关节测试测量的功能障碍，以及通过肩关节活动度测量评估的盂肱关节挛缩。
58名筛查对象中34名被随机分组。受试者平均年龄为52岁。随机分组前疼痛的平均持续时间为1年。治疗组的脱落率为11%，安慰剂组为30%。根据MPQ多维疼痛描述符评分，1个月时治疗组疼痛减轻64%，安慰剂组减轻13%（p = 0.03）。还注意到治疗组肩关节功能改善15.8%，安慰剂组改善4%，差异无统计学意义（p = 0.24）。肩关节活动范围未见改善。除了短暂的迷走神经症状和注射部位局部压痛外，未报告其他副作用。
使用布比卡因肩胛上神经阻滞在1个月时可有效减轻肩周炎疼痛。更多受试者和更长研究周期的临床研究将有助于确定布比卡因肩胛上神经阻滞在治疗肩周炎疼痛、功能障碍和盂肱关节挛缩方面的效果持续时间和性质。
