Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital and University, Turku, Finland.
Arthroscopy. 2013 Jul;29(7):1129-34. doi: 10.1016/j.arthro.2013.04.018.
The purpose of our study was to compare the effectiveness of subacromial bupivacaine infusion and a transdermal fentanyl patch in the treatment of postoperative pain after arthroscopic shoulder surgery.
Sixty patients with rotator cuff disease scheduled for elective arthroscopic shoulder surgery were enrolled in the study. For the treatment of postoperative pain, 30 patients constituted group F and received a 12.0-μg/h fentanyl patch for 72 hours and saline solution infusion in a subacromial manner at the rate of 4 mL/h. The remaining 30 patients constituted group B and received a placebo patch and an infusion of 2.5-mg/mL bupivacaine in a subacromial manner for 72 hours. The primary outcome measure was the postoperative numerical rating scale pain score. The consumption of opioids, ibuprofen, and acetaminophen was also recorded. The Constant scores and general recovery were followed up until the 90th postoperative day.
There was no statistically significant difference in the numerical rating scale scores (P = .60) between the groups. No differences in the use of rescue analgesic were observed except that the patients receiving bupivacaine used more ibuprofen (median, 1,200 mg v 600 mg) during the day of surgery (P = .042). No difference was found in general recovery between the groups.
A fentanyl patch delivering 12-μg/h fentanyl offers an easy and safe treatment option as a part of multimodal analgesia with few adverse effects in the treatment of postoperative pain in a carefully selected patient group after arthroscopic shoulder surgery.
Level I, randomized controlled trial.
本研究旨在比较肩关节炎镜手术后应用肩胛下局部布比卡因输注和经皮芬太尼贴剂治疗术后疼痛的效果。
本研究纳入了 60 例择期行肩关节炎镜手术的肩袖疾病患者。为治疗术后疼痛，30 例患者（F 组）术后接受芬太尼（12.0-μg/h）贴剂，同时行肩胛下 4 mL/h 生理盐水输注，共 72 小时；其余 30 例患者（B 组）术后接受安慰剂贴剂和肩胛下 2.5-mg/mL 布比卡因输注，共 72 小时。主要观察指标为术后数字评分量表（NRS）疼痛评分。记录阿片类药物、布洛芬和对乙酰氨基酚的使用量。在术后第 90 天随访 Constant 评分和总体恢复情况。
两组间 NRS 评分无统计学差异（P=0.60）。除布比卡因组患者在手术当天使用更多布洛芬（中位数 1200mg 比 600mg，P=0.042）外，两组间其他补救性镇痛药物的使用无差异。两组患者的总体恢复情况无差异。
肩胛下给予 12-μg/h 芬太尼的芬太尼贴剂可作为多模式镇痛的一种简便、安全的治疗选择，在精心选择的肩关节炎镜手术后患者中应用，其具有较少的不良反应，可有效治疗术后疼痛。
Ⅰ级，随机对照试验。
