Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Wuerzburg, Germany.
Arch Orthop Trauma Surg. 2010 Apr;130(4):533-40. doi: 10.1007/s00402-009-0985-7. Epub 2009 Oct 20.
Interscalene brachial plexus block (ISB) is widely used as an adjuvant regional pain therapy in patients undergoing major shoulder surgery and has proved its effectiveness on postoperative pain reduction and opioid-sparing effect.
This single-center, prospective, double-blind, randomized and placebo-controlled study was to compare the effectiveness of a single-shot and a patient-controlled catheter insertion ISB system after major open-shoulder surgeries. Seventy patients were entered to receive an ISB and a patient-controlled interscalene catheter. The catheter was inserted under ultrasound guidance. Patients were then assigned to receive one of two different postoperative infusions, either 0.2% ropivacaine (catheter group) or normal saline solution (single-shot group) via a disposable patient-controlled infusion pump.
The study variables were amount of rescue medication, pain at rest and during physiotherapy, patient satisfaction and incidence of unwanted side effects. The ropivacaine group revealed significantly less consumption of rescue medication within the first 24 h after surgery. Incidence of side effects did not differ between the two groups.
Based on our results, we recommend the use of interscalene plexus block in combination with a patient-controlled catheter system under ultrasound guidance only for the first 24 h after major open-shoulder surgery.
经锁骨上臂丛神经阻滞（ISB）广泛应用于行肩部大手术的患者作为辅助区域疼痛治疗，已被证实具有减少术后疼痛和减少阿片类药物用量的效果。
本单中心前瞻性双盲随机对照研究旨在比较单次注射和患者自控导管插入 ISB 系统在大开放式肩部手术后的效果。70 名患者接受 ISB 和患者自控经锁骨下导管。在超声引导下插入导管。然后，患者被分配接受两种不同的术后输注，一种是 0.2%罗哌卡因（导管组），另一种是生理盐水溶液（单次注射组），通过一次性患者自控输注泵。
研究变量包括抢救药物的用量、休息和理疗时的疼痛、患者满意度和不良反应发生率。在手术后 24 小时内，罗哌卡因组的抢救药物用量明显减少。两组的不良反应发生率无差异。
根据我们的结果，我们建议在超声引导下仅对大开放式肩部手术后的前 24 小时使用经锁骨下神经丛阻滞联合患者自控导管系统。
