Klein S M, Grant S A, Greengrass R A, Nielsen K C, Speer K P, White W, Warner D S, Steele S M
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Anesth Analg. 2000 Dec;91(6):1473-8. doi: 10.1097/00000539-200012000-00033.
Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve block, with a reliable method of catheter insertion, and a self-contained infusion system would be a valuable asset for short-stay care. We compared the efficacy of single injection interscalene brachial plexus blockade to a continuous peripheral nerve block, with an insulated Tuohy system and a disposable infusion pump. Forty adult patients scheduled for open rotator cuff repair were entered in this randomized, double-blinded, placebo-controlled study. Patients received an interscalene brachial plexus blockade and a continuous peripheral nerve catheter as their primary anesthetic and then, were assigned to receive one of two different postoperative infusions: either 0.2% ropivacaine at 10 mL/h via a disposable infusion pump or normal saline at 10 mL/h via a disposable infusion pump (n = 18-20 per group). Visual analog pain scores and postoperative morphine consumption were measured for 24 h. The ropivacaine group showed less pain than the placebo group (P: = 0.0001) between 12 and 24 h after the initial injection of local anesthetic. In addition, initial interscalene blockade was successful in all patients and all redosed catheters were functional after 24 h with the continuous catheter insertion system. We conclude that it is possible to achieve a high rate of successful catheter placement and analgesia by using the continuous catheter insertion system and a disposable infusion pump in the ambulatory setting. This method of analgesia may offer improved pain relief after outpatient rotator cuff repair.
传统上，连续肌间沟臂丛神经阻滞需要住院进行局部麻醉药输注，且难以实现一致的导管插入。将连续外周神经阻滞带来的长效疼痛缓解、可靠的导管插入方法以及独立的输注系统相结合，对于短期护理而言将是一项宝贵资产。我们比较了单次注射肌间沟臂丛神经阻滞与使用绝缘Tuohy系统和一次性输注泵进行的连续外周神经阻滞的疗效。40例计划行开放性肩袖修补术的成年患者进入了这项随机、双盲、安慰剂对照研究。患者接受肌间沟臂丛神经阻滞和连续外周神经导管作为主要麻醉方式，然后被分配接受两种不同的术后输注之一：通过一次性输注泵以10 mL/h的速度输注0.2%罗哌卡因，或通过一次性输注泵以10 mL/h的速度输注生理盐水（每组n = 18 - 20）。在24小时内测量视觉模拟疼痛评分和术后吗啡消耗量。在首次注射局部麻醉药后的12至24小时之间，罗哌卡因组的疼痛程度低于安慰剂组（P = 0.0001）。此外，初始肌间沟阻滞在所有患者中均成功，并且使用连续导管插入系统时，所有重新给药的导管在24小时后均功能正常。我们得出结论，在门诊环境中使用连续导管插入系统和一次性输注泵可以实现高成功率的导管放置和镇痛。这种镇痛方法可能会改善门诊肩袖修补术后的疼痛缓解情况。
