Bowens Clifford, Sripada Ramprasad
Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, 4648 The Vanderbilt Clinic, Nashville, TN 37232-5614, USA.
Anesthesiol Res Pract. 2012;2012:971963. doi: 10.1155/2012/971963. Epub 2012 Jun 25.
The article reviews the current literature regarding shoulder anesthesia and analgesia. Techniques and outcomes are presented that summarize our present understanding of regional anesthesia for the shoulder. Shoulder procedures producing mild to moderate pain may be managed with a single-injection interscalene block. However, studies support that moderate to severe pain, lasting for several days is best managed with a continuous interscalene block. This may cause increased extremity numbness, but will provide greater analgesia, reduce supplemental opioid consumption, improve sleep quality and patient satisfaction. In comparison to the nerve stimulation technique, ultrasound can reduce the volume of local anesthetic needed to produce an effective interscalene block. However, it has not been shown that ultrasound offers a definitive benefit in preventing major complications. The evidence indicates that the suprascapular and/or axillary nerve blocks are not as effective as an interscalene block. However in patients who are not candidates for the interscalene block, these blocks may provide a useful alternative for short-term pain relief. There is substantial evidence showing that subacromial and intra-articular injections provide little clinical benefit for postoperative analgesia. Given that these injections may be associated with irreversible chondrotoxicity, the injections are not presently recommended.
本文回顾了目前有关肩部麻醉和镇痛的文献。文中介绍了一些技术和结果，总结了我们目前对肩部区域麻醉的理解。产生轻至中度疼痛的肩部手术可用单次注射肌间沟阻滞来处理。然而，研究表明，持续数天的中至重度疼痛最好采用连续肌间沟阻滞来处理。这可能会导致肢体麻木加重，但能提供更好的镇痛效果，减少辅助性阿片类药物的用量，改善睡眠质量并提高患者满意度。与神经刺激技术相比，超声可减少产生有效肌间沟阻滞所需的局部麻醉药用量。然而，尚未证明超声在预防主要并发症方面有明确的益处。有证据表明，肩胛上神经和/或腋神经阻滞不如肌间沟阻滞有效。然而，对于不适合进行肌间沟阻滞的患者，这些阻滞可为短期缓解疼痛提供有用的替代方法。有大量证据表明，肩峰下注射和关节内注射对术后镇痛几乎没有临床益处。鉴于这些注射可能与不可逆的软骨毒性有关，目前不推荐进行此类注射。
