Clinical Senior Lecturer.
Specialist Registrar, Department of Anaesthesiology, University of Auckland, Epsom, Auckland, New Zealand.
Anaesthesia. 2010 Jun;65(6):608-624. doi: 10.1111/j.1365-2044.2009.06231.x.
Shoulder surgery is well recognised as having the potential to cause severe postoperative pain. The aim of this review is to assess critically the evidence relating to the effectiveness of regional anaesthesia techniques commonly used for postoperative analgesia following shoulder surgery. Subacromial/intra-articular local anaesthetic infiltration appears to perform only marginally better than placebo, and because the technique has been associated with catastrophic chondrolysis, it can no longer be recommended. All single injection nerve blocks are limited by a short effective duration. Suprascapular nerve block reduces postoperative pain and opioid consumption following arthroscopic surgery, but provides inferior analgesia compared with single injection interscalene block. Continuous interscalene block incorporating a basal local anaesthetic infusion and patient controlled boluses is the most effective analgesic technique following both major and minor shoulder surgery. However, interscalene nerve block is an invasive procedure with potentially serious complications and should therefore only be performed by practitioners with appropriate experience.
肩部手术被公认为有引起严重术后疼痛的潜力。本综述的目的是批判性评估与肩部手术后常用的区域麻醉技术的有效性相关的证据。肩峰下/关节内局部麻醉浸润似乎仅比安慰剂稍好，但由于该技术与灾难性软骨溶解有关，因此不再推荐使用。所有单次注射神经阻滞的有效时间都很有限。肩胛上神经阻滞可减少关节镜手术后的术后疼痛和阿片类药物的消耗，但与单次注射肌间沟阻滞相比，其镇痛效果较差。包含基础局部麻醉输注和患者自控推注的连续肌间沟阻滞是大、小肩部手术后最有效的镇痛技术。然而，肌间沟神经阻滞是一种具有潜在严重并发症的侵入性操作，因此应由具有适当经验的医生进行操作。
