Fredrickson Michael J, Ball Craig M, Dalgleish Adam J
Department of Anesthesiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Reg Anesth Pain Med. 2008 Mar-Apr;33(2):122-8. doi: 10.1016/j.rapm.2007.09.007.
Large prospective studies evaluating continuous interscalene block for shoulder surgery have thus far been limited to inpatient and university teaching practices. Shoulder surgery is increasingly being performed on an outpatient basis. The aim of this case series was to prospectively evaluate a large series of interscalene catheters for ambulatory shoulder surgery in a private practice setting.
A single operator placed nonstimulating catheters using a combination of ultrasound and nerve stimulation. Following postanesthesia care unit (PACU) discharge, opioid-like analgesic adjuvants other than tramadol were avoided unless patients experienced inadequate pain relief. All patients were assessed in the PACU, on the first postoperative morning, and at 3 weeks for catheter effectiveness and for acute and chronic complications. Pain scores and patient satisfaction were assessed in subgroups of 100 consecutive patients.
Three hundred patients were studied. The first attempt catheter success rate was 96%. In all but 1 patient, ineffective catheters in the PACU were effectively reinserted. Thirteen patients experienced inadequate pain relief after leaving the PACU. Of these patients, 5 were rescued with additional ropivacaine, 3 had the catheter effectively reinserted, and 5 were managed with oral opioids. One patient required antibiotic treatment for catheter site infection. Neurological sequelae potentially attributable to the catheter were present in 3 patients at 3 weeks, and remained in 1 patient at 4 weeks. This patient's symptoms resolved at 6 months.
Continuous interscalene block for ambulatory shoulder surgery in a private practice setting had a high success rate, a low complication rate, and enabled the avoidance of the use of potent opioids in 98% of patients.
迄今为止，评估连续肌间沟阻滞用于肩部手术的大型前瞻性研究仅限于住院患者及大学教学实践。肩部手术越来越多地在门诊进行。本病例系列的目的是在私人诊所环境中前瞻性评估大量用于门诊肩部手术的肌间沟导管。
由一名操作者使用超声和神经刺激相结合的方法放置非刺激性导管。在麻醉后护理单元（PACU）出院后，除非患者疼痛缓解不足，否则避免使用曲马多以外的阿片类镇痛辅助药物。所有患者在PACU、术后第一个早晨以及3周时接受评估，以评估导管的有效性以及急性和慢性并发症。在连续100例患者的亚组中评估疼痛评分和患者满意度。
共研究了300例患者。首次尝试导管成功率为96%。除1例患者外，PACU中无效的导管均成功重新插入。13例患者在离开PACU后疼痛缓解不足。其中，5例患者通过追加罗哌卡因得到缓解，3例患者导管成功重新插入，5例患者使用口服阿片类药物治疗。1例患者因导管部位感染接受抗生素治疗。3周时3例患者出现可能归因于导管的神经后遗症，4周时1例患者仍有后遗症。该患者的症状在6个月时缓解。
在私人诊所环境中，连续肌间沟阻滞用于门诊肩部手术成功率高、并发症发生率低，并且98%的患者无需使用强效阿片类药物。
