Desai Neel
Specialist Registrar in Anaesthetics, Department of Anaesthetics, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP.
Br J Hosp Med (Lond). 2017 Sep 2;78(9):511-515. doi: 10.12968/hmed.2017.78.9.511.
Both arthroscopic and open surgery of the shoulder are associated with significant postoperative pain. Use of opioids can result in adverse systemic effects, so a multi-modal analgesic approach and complementary analgesic techniques should be considered to minimize the postoperative opioid requirement. Single shot interscalene block provides effective pain control of early and limited duration which can be extended with a catheter. Continuous interscalene block should be considered for more invasive shoulder procedures. However, interscalene block is associated with hemidiaphragmatic paresis which is a substantial risk in patients with serious pulmonary pathology who could otherwise benefit most from a regional technique and the avoidance of opioids. Local infiltration analgesia, and suprascapular nerve block with or without axillary nerve block, have not been consistently shown to be superior to or as effective as interscalene block and there is insufficient evidence to support the use of supraclavicular block over interscalene block.
肩关节的关节镜手术和开放手术均会导致明显的术后疼痛。使用阿片类药物会产生不良的全身影响，因此应考虑采用多模式镇痛方法和辅助镇痛技术，以尽量减少术后对阿片类药物的需求。单次肌间沟阻滞可提供早期且作用时间有限的有效疼痛控制，可通过导管延长其作用时间。对于更具侵入性的肩部手术，应考虑持续肌间沟阻滞。然而，肌间沟阻滞与半膈肌麻痹有关，这对于患有严重肺部疾病的患者是一个重大风险，而这些患者原本可能从区域技术和避免使用阿片类药物中获益最大。局部浸润镇痛以及肩胛上神经阻滞（无论是否联合腋神经阻滞），并未始终显示出优于肌间沟阻滞或与之效果相当，而且也没有足够的证据支持使用锁骨上阻滞而非肌间沟阻滞。
