Ilfeld Brian M, Vandenborne Krista, Duncan Pamela W, Sessler Daniel I, Enneking F Kayser, Shuster Jonathan J, Theriaque Douglas W, Chmielewski Terese L, Spadoni Eugene H, Wright Thomas W
Department of Anesthesiology, University of Florida, Gainsville, Florida, USA.
Anesthesiology. 2006 Nov;105(5):999-1007. doi: 10.1097/00000542-200611000-00022.
A continuous interscalene nerve block (CISB) may be used to provide analgesia after shoulder arthroplasty. Therefore, inpatient stays may be shortened if CISB (1) provides adequate analgesia without intravenous opioids and (2) improves shoulder mobilization. This study investigated the relationship between ambulatory CISB and the time to reach three discharge criteria after shoulder arthroplasty.
Preoperatively, patients received a CISB. All patients received a perineural 0.2% ropivacaine infusion from surgery until 06:00 the following morning, at which time they were randomly assigned either to continue perineural ropivacaine or to switch to normal saline. The primary endpoint was the time from the end of surgery until three discharge criteria were attained (adequate analgesia, independence from intravenous analgesics, and tolerance to 50% of shoulder motion targets). Patients were discharged home as early as the afternoon after surgery with their CISB using a portable infusion pump.
Patients receiving perineural ropivacaine (n = 16) attained all three discharge criteria in a median (10th-90th percentiles) of 21 (16-41) h, compared with 51 (37-90) h for those receiving perineural normal saline (n = 13, P < 0.001). Unlike patients receiving perineural ropivacaine, patients receiving perineural normal saline often required intravenous morphine, but still experienced a higher degree of pain and tolerated less external rotation.
An ambulatory CISB considerably decreases the time until readiness for discharge after shoulder arthroplasty, primarily by providing potent analgesia that permits greater passive shoulder movement and the avoidance of intravenous opioids. Additional research is required to define the appropriate subset of patients and assess the incidence of complications associated with earlier discharge.
连续肌间沟神经阻滞（CISB）可用于肩部置换术后镇痛。因此，如果CISB（1）在不使用静脉注射阿片类药物的情况下提供充分镇痛，以及（2）改善肩部活动度，住院时间可能会缩短。本研究调查了门诊CISB与肩部置换术后达到三项出院标准的时间之间的关系。
术前，患者接受CISB。所有患者从手术开始至次日上午06:00接受0.2%罗哌卡因神经周围输注，届时他们被随机分配继续接受神经周围罗哌卡因输注或改用生理盐水。主要终点是从手术结束到达到三项出院标准（充分镇痛、无需静脉注射镇痛药、耐受50%的肩部活动目标）的时间。患者在术后当天下午最早使用便携式输注泵带着CISB出院回家。
接受神经周围罗哌卡因的患者（n = 16）达到所有三项出院标准的中位时间（第10 - 90百分位数）为21（16 - 41）小时，而接受神经周围生理盐水的患者（n = 13）为51（37 - 90）小时（P < 0.001）。与接受神经周围罗哌卡因的患者不同，接受神经周围生理盐水的患者经常需要静脉注射吗啡，但仍经历更高程度的疼痛且外旋耐受性较低。
门诊CISB可显著缩短肩部置换术后准备出院的时间，主要是通过提供有效的镇痛，从而允许更大程度的被动肩部活动并避免静脉注射阿片类药物。需要进一步研究以确定合适的患者亚组，并评估与早期出院相关的并发症发生率。
