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关节镜下肩袖修复术后,与连续肌间沟臂丛神经阻滞相比,关节周围多模式药物注射不能改善术后早期镇痛效果:一项回顾性单中心对照研究。

Periarticular multimodal drug injection does not improves early postoperative analgesia compared with continuous interscalene brachial plexus block after arthroscopic rotator cuff repair: A retrospective single-center comparative study.

作者信息

Toyooka Seikai, Ito Masaaki, Kakinuma Akihito, Kayama Satoru, Watanabe Kazuyuki, Miyamoto Wataru, Nakagawa Takumi, Kawano Hirotaka

机构信息

Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan.

Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan.

出版信息

J Orthop Sci. 2020 May;25(3):405-409. doi: 10.1016/j.jos.2019.04.013. Epub 2019 May 29.

Abstract

BACKGROUND

Although continuous interscalene brachial plexus block (CISBPB) is common method in pain management following arthroscopic rotator cuff repair (ARCR), little is known about the analgesic effects of periarticular multimodal drug injection (PMDI) for ARCR. This retrospective study sought to clarify which technique could provide the best analgesic effect after ARCR.

METHODS

We retrospectively reviewed consecutive patients who underwent ARCR performed by the same surgeon at our institution between June 2016 and November 2017. Patients who underwent surgery before January 2017 received CISBPB and those who underwent surgery after February 2017 received PMDI for postoperative pain control. Both treatment groups also received fentanyl by intravenous patient-controlled analgesia (IV-PCA). Postoperative pain was evaluated by visual analog scale (VAS) pain scores at 3, 6, 12, 24, and 48 h and need for IV-PCA at 8, 16, and 24 h.

RESULTS

Twenty-eight patients received CISBPB and 21 received PMDI. According to the VAS scores, the postoperative analgesic effect was significantly better in the CISBPB group during the first 6 h (p < 0.05). Total fentanyl consumption by IV-PCA during the first 8 postoperative h was significantly greater in the PMDI group than in the CISBPB group.

CONCLUSIONS

PMDI does not improve early postoperative analgesia after ARCR compared with CISBPB. CISBPB had a significantly better analgesic effect in the first 8 h postoperatively.

LEVEL OF EVIDENCE

Level III.

摘要

背景

尽管连续肌间沟臂丛神经阻滞(CISBPB)是关节镜下肩袖修复术(ARCR)后疼痛管理的常用方法,但关于关节周围多模式药物注射(PMDI)对ARCR的镇痛效果知之甚少。这项回顾性研究旨在明确哪种技术在ARCR后能提供最佳镇痛效果。

方法

我们回顾性分析了2016年6月至2017年11月在我院由同一位外科医生进行ARCR的连续患者。2017年1月前接受手术的患者采用CISBPB,2017年2月后接受手术的患者采用PMDI进行术后疼痛控制。两个治疗组均通过静脉自控镇痛(IV-PCA)给予芬太尼。术后疼痛通过视觉模拟量表(VAS)在3、6、12、24和48小时的疼痛评分以及在8、16和24小时对IV-PCA的需求进行评估。

结果

28例患者接受了CISBPB,21例接受了PMDI。根据VAS评分,CISBPB组在前6小时的术后镇痛效果明显更好(p<0.05)。术后前8小时,PMDI组通过IV-PCA的芬太尼总消耗量明显高于CISBPB组。

结论

与CISBPB相比,PMDI并不能改善ARCR术后的早期镇痛效果。CISBPB在术后前8小时的镇痛效果明显更好。

证据级别

三级。

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