Winkler Tobias, Suda Arnold J, Dumitrescu Radu V, Pinggera Oswald, Weber Georg, Loho Gerald, Schneider Barbara, Wurnig Christian
Center of Musculoskeletal Surgery, Department of Orthopaedics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):566-72. doi: 10.1016/j.jse.2008.11.005. Epub 2009 Feb 11.
Interscalene and subacromial infusion of local anesthetics have both been shown to be effective in alleviating pain after shoulder arthroscopy. We performed a prospective randomized clinical trial in which both methods were compared in patients after acromioplasty.
Forty patients received a subacromial (n = 20) or an interscalene (n = 20) continuous infusion of 2% ropivacaine (2 mL/h) after arthroscopic acromioplasty. Visual analog scale pain scores, additional medication requirements, and side effects were evaluated for 43 hours. The incidence of night pain was recorded.
Compared with the subacromial infusion, the continuous interscalene infusion of ropivacaine in the operated-on shoulder resulted in significantly reduced visual analog scale pain scores measured during rest, and also during exercise at 8 and 12 hours after surgery. The incidence of night pain was significantly lower in the interscalene group (P = .018).
A continuous subacromial infusion of 0.2% ropivacaine (2 mL/h) is inferior to continuous interscalene infusion, particularly during the first 12 hours, but could be an alternative in patients with contraindications of interscalene anesthesia or when acromioplasty is performed as an outpatient procedure.
在肩关节镜检查后，肌间沟和肩峰下注射局部麻醉剂均已被证明可有效缓解疼痛。我们进行了一项前瞻性随机临床试验，对接受肩峰成形术的患者比较了这两种方法。
40例患者在关节镜下肩峰成形术后接受肩峰下（n = 20）或肌间沟（n = 20）持续输注2%罗哌卡因（2 mL/h）。评估43小时的视觉模拟评分疼痛分数、额外药物需求和副作用。记录夜间疼痛的发生率。
与肩峰下输注相比，在患侧肩部持续肌间沟输注罗哌卡因可使术后8小时和12小时休息及运动期间测得的视觉模拟评分疼痛分数显著降低。肌间沟组夜间疼痛的发生率显著更低（P = 0.018）。
持续肩峰下输注0.2%罗哌卡因（2 mL/h）不如持续肌间沟输注，尤其是在最初12小时内，但对于有肌间沟麻醉禁忌证的患者或门诊进行肩峰成形术的患者，它可能是一种替代方法。
