Schwemmer U, Greim C A, Boehm T D, Papenfuss T, Markus C K, Roewer N, Gohlke F
Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg.
Schmerz. 2004 Dec;18(6):475-80. doi: 10.1007/s00482-004-0329-z.
Surgical procedures in the region of the shoulder joint are among the most painful interventions in orthopedic practice. For this reason, in addition to intravenous pain therapy with opioids, blockade of the brachial plexus has become established as an effective method to provide analgesia.High-resolution ultrasound offers the possibility of performing nerve blockades under visual monitoring. Studies on interscalene blockade performed under sonographic control provide evidence for both the high efficacy and safety of the procedure. Clinically manifest signs of nerve damage have not appeared with use of this method. Smaller operations can usually be adequately managed with perioperative single-shot blockade. More extensive operations for which severe pain lasting for several days can be expected and surgical interventions involving preexistent shoulder stiffness necessitate catheterization for uninterrupted pain therapy. Successful rehabilitation after shoulder surgery requires diligent perioperative pain blockade, which can primarily be provided by interscalene plexus blockade.
肩关节区域的外科手术是骨科实践中最痛苦的干预措施之一。因此，除了使用阿片类药物进行静脉疼痛治疗外，臂丛神经阻滞已成为一种有效的镇痛方法。高分辨率超声使在视觉监测下进行神经阻滞成为可能。在超声引导下进行的肌间沟阻滞研究为该手术的高效性和安全性提供了证据。使用这种方法尚未出现神经损伤的临床表现。较小的手术通常可以通过围手术期单次阻滞得到充分管理。对于预计会有持续数天的严重疼痛的更广泛手术以及涉及既往肩部僵硬情况的外科干预，需要进行导管插入以进行不间断的疼痛治疗。肩部手术后的成功康复需要认真进行围手术期疼痛阻滞，这主要可以通过肌间沟神经丛阻滞来实现。
