Karaman Tugba, Karaman Serkan, Aşçı Murat, Tapar Hakan, Şahin Aynur, Dogru Serkan, Suren Mustafa
Department of Anesthesiology and Reanimation, School of Medicine, Gaziosmanpasa University, Tokat, Turkey.
Department of Orthopedics and Traumatology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey.
Pain Pract. 2019 Feb;19(2):196-203. doi: 10.1111/papr.12733. Epub 2018 Nov 20.
The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)-guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery.
A total of 62 adult patients scheduled for arthroscopic shoulder surgery under general anesthesia were randomized into 2 groups to receive either ISBB (IB group, n = 31) or SCBB (SB group, n = 29) with 20 mL of 0.25% bupivacaine under US guidance. Assessments included postoperative pain scores, additional analgesic requirement, timing of the first analgesic requirement, Quality of Recovery-40 (QoR-40) scores, block characteristics, and side effects.
No significant differences were found between the 2 groups for pain scores (P = 0.34), timing of first analgesic requirement (P = 0.30), additional analgesic requirement (P = 0.34), or QoR-40 scores (P = 0.13). The block characteristics regarding procedure time (P = 0.95), block failure, and onset time of sensory blockade (P = 0.33) were similar. Horner's syndrome occurred in 8 patients in the IB group and 1 patient in the SB group (P = 0.015).
This study showed that US-guided SCBB is as effective as ISBB in reducing postoperative pain and improving the quality of recovery for arthroscopic shoulder surgery.
肌间沟臂丛神经阻滞（ISBB）是一种有效减少关节镜下肩部手术后阿片类药物用量和疼痛的方法。超声（US）引导下锁骨上臂丛神经阻滞（SCBB）似乎是关节镜下肩部手术的另一种技术。然而，关于SCBB对关节镜下肩部手术后疼痛管理和恢复的影响，目前缺乏证据。本研究的目的是比较SCBB与ISBB在关节镜下肩部手术后疼痛和恢复质量方面的效果。
总共62例计划在全身麻醉下进行关节镜下肩部手术的成年患者被随机分为两组，在超声引导下分别接受ISBB（IB组，n = 31）或SCBB（SB组，n = 29），注射20 mL 0.25%布比卡因。评估包括术后疼痛评分、额外镇痛需求、首次镇痛需求时间、恢复质量-40（QoR-40）评分、阻滞特征和副作用。
两组在疼痛评分（P = 0.34）、首次镇痛需求时间（P = 0.30）、额外镇痛需求（P = 0.34）或QoR-40评分（P = 0.13）方面均未发现显著差异。关于操作时间（P = 0.95）、阻滞失败和感觉阻滞起效时间（P = 0.33）的阻滞特征相似。IB组有8例患者出现霍纳综合征，SB组有1例患者出现霍纳综合征（P = 0.015）。
本研究表明，超声引导下的SCBB在减轻关节镜下肩部手术后疼痛和改善恢复质量方面与ISBB同样有效。
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