Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France.
Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France.
J Shoulder Elbow Surg. 2019 Feb;28(2):212-219. doi: 10.1016/j.jse.2018.09.026. Epub 2018 Dec 10.
The aim of this study was to compare the efficacy of local infiltration analgesia (LIA) and interscalene nerve block (ISB) for early postoperative pain control after total shoulder arthroplasty (TSA). The hypothesis was that LIA is not inferior to ISB.
A prospective, randomized controlled study was performed in 2014-2016. All patients who underwent TSA for shoulder osteoarthritis were included. Patients in the ISB group received a continuous infusion of 0.2% ropivacaine by perineural catheter for 48 hours. The surgeon injected 110 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and 0.5 mg of epinephrine before TSA in the LIA group and inserted a catheter into the glenohumeral joint. The next morning, 10 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and epinephrine were injected through the catheter, which was then removed. The primary outcome was the mean shoulder pain score for the 48-hour postoperative period on a numerical scale (0-10). The secondary outcomes were postoperative opioid requirements, complications, and shoulder function at the 1-month follow-up visit. The sample size was calculated for a noninferiority study.
The study included 99 patients (50 LIA and 49 ISB patients) with a mean age of 72 ± 9.6 years. Although no significant difference in the mean pain score was found between the 2 groups for the 48-hour postoperative period (1.4 ± 0.9 for LIA vs 1.7 ± 1 for ISB, P = .19), the LIA group had significantly less severe pain (P = .003) and less opioid consumption (P = .01) in the recovery room. No complications occurred. A negative but nonsignificant correlation was found between postoperative pain and Constant score at the 1-month follow-up.
LIA is not less effective than ISB for early postoperative pain control after TSA.
本研究旨在比较局部浸润镇痛（LIA）和肌间沟神经阻滞（ISB）在全肩关节置换术后早期控制疼痛的效果。假设是 LIA 并不逊于 ISB。
这是一项前瞻性、随机对照研究，于 2014 年至 2016 年进行。所有接受肩关节炎全肩关节置换术的患者均纳入本研究。ISB 组患者通过神经周围导管接受 0.2%罗哌卡因持续输注 48 小时。LIA 组患者在全肩关节置换术前向关节周围注射 110ml 0.2%罗哌卡因、30mg 酮咯酸和 0.5mg 肾上腺素，并将导管插入盂肱关节。第二天早上，通过导管注入 10ml 0.2%罗哌卡因、30mg 酮咯酸和肾上腺素，然后将导管拔出。主要结局是术后 48 小时内数字评分法（0-10）的平均肩部疼痛评分。次要结局是术后阿片类药物需求、并发症和 1 个月随访时的肩部功能。根据非劣效性研究计算了样本量。
该研究纳入了 99 例患者（50 例 LIA 组和 49 例 ISB 组），平均年龄为 72±9.6 岁。虽然两组患者术后 48 小时的平均疼痛评分无显著差异（LIA 组为 1.4±0.9，ISB 组为 1.7±1.0，P=0.19），但 LIA 组在恢复室的疼痛程度较轻（P=0.003），阿片类药物用量较少（P=0.01）。未发生并发症。在 1 个月随访时，术后疼痛与 Constant 评分呈负相关，但无统计学意义。
LIA 在全肩关节置换术后早期控制疼痛方面并不逊于 ISB。
