Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
Curr Opin Anaesthesiol. 2011 Dec;24(6):638-43. doi: 10.1097/ACO.0b013e32834c155f.
There have been several recent insights in our understanding of how best to provide optimal perioperative anesthesia and analgesia for ambulatory shoulder surgery. This review attempts to distill the advances reported in the past 12-18 months and put them in perspective.
Recent studies have explored the optimal dosing regimens and techniques for single-shot and continuous nerve blocks with regard to block effectiveness and complications. Further rigorously conducted studies into postoperative neurological and respiratory complications are correlated with study findings of brachial plexus anatomy. Evidence is presented supporting supraclavicular brachial plexus block as an equivalent alternative to interscalene block for ambulatory shoulder surgery.
Following recent findings it is likely that the use of supraclavicular block will become more popular for shoulder surgery. However, further large-scale trials will be needed to definitively prove its advantages over the traditional interscalene block. On the contrary, the precision of ultrasound guidance and the ongoing optimization of postoperative continuous anesthetic infusion regimens continue to improve the performance characteristics of interscalene block.
在理解如何为门诊肩部手术提供最佳围手术期麻醉和镇痛方面，我们最近有了一些新的认识。本综述试图梳理过去 12-18 个月报告的进展，并进行分析。
最近的研究探讨了单次和连续神经阻滞的最佳剂量方案和技术，包括阻滞效果和并发症。进一步对术后神经和呼吸并发症进行严格的研究与臂丛解剖的研究结果相关。有证据表明，锁骨上臂丛阻滞可作为门诊肩部手术的一种等效替代方法，与肌间沟阻滞相当。
根据最近的研究结果，锁骨上阻滞在肩部手术中的应用可能会更加流行。然而，还需要进行大规模的试验来明确证明其优于传统的肌间沟阻滞。相反，超声引导的精确性和术后连续麻醉输注方案的不断优化继续提高肌间沟阻滞的性能特征。
