[用于全肩关节置换术的肌间沟阻滞：比较研究（超声与神经刺激）]

[Interscalene block for total shoulder arthroplasty: comparative study (ultrasound vs. neurostimulation)].

作者信息

Mejía-Terrazas Gabriel Enrique, Ruiz-Suárez Michell, Gaspar-Carrillo Sandra Patricia, Valero-González Fernando, Unzueta-Navarro David, Encalada-Díaz Iván

机构信息

División de Anestesiología, Instituto Nacional de Rehabilitación, Xochimilco, México DF, Mexico.

Servicio de Ortopedia, Fundación Clínica Médica Sur, Xochimilco, México DF, Mexico.

出版信息

Cir Cir. 2014 Jul-Aug;82(4):381-8.

PMID:25167348

Abstract

BACKGROUND

Modern anesthesiology has integrated the use of ultrasonography as a tool that has displaced neurostimulation as a technique for locating peripheral nerves. The aim of this study was to determine which procedure is more effective for guiding interscalene block for total shoulder arthroplasty.

METHODS

We carried out a comparative, prospective non-randomized study comprised of the group guided by neurostimulation interscalene block and the group guided by ultrasound. All patients in both groups were scheduled for total shoulder arthroplasty. Latency, degree of sensory and motor block, success rate, postoperative pain intensity at 6, 12, and 24 h, patient satisfaction and complications were measured.

RESULTS

We included 110 patients, 55 per group. Patients were placed in beach chair position and the deltopectoral approach was used. There were no differences in demographic characteristics. Results for neurostimulation vs. ultrasound group: latency 19.11 ± 2.27 vs. 17.24 ± 1.42 min, p= 0.23. Block sensitivity in both groups was grade 0 motor block grade 0 in 76.4% and grade 1 in 23.6% vs. grade 0 to 100%. There was 100% success rate for both groups. Postoperative pain at 6 h was 0.13 ± 0.54 vs. 0.11 ± 0.13 p= 0.90, at 12 h 1.67 ± 1.15 vs. 1.65 ± 0.59 p= 0.89 and at 24 h 3.15 ± 1.66 vs. 2.99 ± 1.15 p= 0.78. Satisfaction 54.5% very satisfied and 45.5% satisfied 96.36% vs 3.6% very satisfied and satisfied. Complications 18.18% vs. 3.6% p= 0.023.

CONCLUSION

Ultrasound-guided interscalene nerve block is the technique of choice in elective total shoulder arthroplasty.

摘要

背景

现代麻醉学已将超声检查作为一种工具加以应用，其取代了神经刺激技术用于定位周围神经。本研究的目的是确定哪种方法在引导全肩关节置换术的肌间沟阻滞方面更有效。

方法

我们进行了一项比较性、前瞻性非随机研究，包括神经刺激引导肌间沟阻滞组和超声引导组。两组所有患者均计划接受全肩关节置换术。测量潜伏期、感觉和运动阻滞程度、成功率、术后6小时、12小时和24小时的疼痛强度、患者满意度及并发症。

结果

我们纳入了110例患者，每组55例。患者置于沙滩椅位，采用三角肌胸大肌入路。人口统计学特征无差异。神经刺激组与超声组结果比较：潜伏期19.11±2.27分钟对17.24±1.42分钟，p = 0.23。两组阻滞敏感性方面，运动阻滞0级在神经刺激组为76.4%，1级为23.6%，而超声组为0级至100%。两组成功率均为100%。术后6小时疼痛程度0.13±0.54对0.11±0.13，p = 0.90；12小时1.67±1.15对1.65±0.59，p = 0.89；24小时3.15±1.66对2.99±1.15，p = 0.78。满意度方面，非常满意和满意的比例在神经刺激组为54.5%，超声组为96.36%对3.6%。并发症发生率分别为18.18%对3.6%，p = 0.023。