Klein S M, Nielsen K C, Martin A, White W, Warner D S, Steele S M, Speer K P, Greengrass R A
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Anesth Analg. 2001 Sep;93(3):601-5. doi: 10.1097/00000539-200109000-00015.
Providing intraarticular analgesia with a continuous infusion of local anesthetic via a disposable infusion pump has gained popularity. Despite the prevalence of this technique, data comparing this method of analgesia to conventional regional anesthesia are not available. We present a prospective study that compared a single-dose interscalene block with a single-dose interscalene block plus continuous intraarticular infusion of local anesthetic. Forty patients scheduled for shoulder arthroscopy were entered in this prospective, double-blinded study. All patients received an interscalene brachial plexus block as their primary anesthetic. Patients were randomly assigned to 1 of 2 groups: 1. interscalene block with 1.5% mepivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.5% ropivacaine at 2 mL/h, or 2. interscalene block with 0.5% ropivacaine (40 mL) followed by a postoperative intraarticular infusion of 0.9% saline (placebo) at 2 mL/h. Postoperative infusions were maintained for 48 h. Visual analog scale pain scores and postoperative oxycodone consumption were measured for 48 h. Visual analog scale scores at rest and with ambulation in the Mepivacaine/Intraarticular Ropivacaine group were reduced when compared with the Ropivacaine/Saline group (rest: P = 0.003, ambulation: P = 0.006). Oxycodone consumption was also decreased (28 +/- 21 mg vs 44 +/- 28 mg, P = 0.046), respectively. We conclude that a brachial plexus block with 1.5% mepivacaine and a continuous intraarticular infusion of 0.5% ropivacaine at 2 mL/h provides improved analgesia for minor surgery at 24 and 48 h versus a single-injection interscalene block with 0.5% ropivacaine.
通过一次性输液泵持续输注局部麻醉药进行关节内镇痛已越来越普遍。尽管这种技术很流行，但将这种镇痛方法与传统区域麻醉进行比较的数据却不可得。我们进行了一项前瞻性研究，比较了单剂量肌间沟阻滞与单剂量肌间沟阻滞加局部麻醉药持续关节内输注。40例计划行肩关节镜检查的患者纳入了这项前瞻性双盲研究。所有患者均接受肌间沟臂丛神经阻滞作为主要麻醉方法。患者被随机分为2组中的1组：1. 用1.5%甲哌卡因（40 mL）进行肌间沟阻滞，术后以2 mL/h的速度关节内输注0.5%罗哌卡因；或2. 用0.5%罗哌卡因（40 mL）进行肌间沟阻滞，术后以2 mL/h的速度关节内输注0.9%生理盐水（安慰剂）。术后输注维持48小时。测量48小时的视觉模拟评分疼痛分数和术后羟考酮消耗量。与罗哌卡因/生理盐水组相比，甲哌卡因/关节内罗哌卡因组静息和行走时的视觉模拟评分分数降低（静息：P = 0.003，行走：P = 0.006）。羟考酮消耗量也分别降低（28±21 mg对44±28 mg，P = 0.046）。我们得出结论，与用0.5%罗哌卡因单次注射肌间沟阻滞相比，用1.5%甲哌卡因进行臂丛神经阻滞并以2 mL/h的速度持续关节内输注0.5%罗哌卡因，在24小时和48小时时为小手术提供了更好的镇痛效果。
