Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2019 Oct;28(10):e325-e338. doi: 10.1016/j.jse.2019.05.013. Epub 2019 Jul 26.
The ideal analgesic modality for total shoulder arthroplasty (TSA) remains controversial. We hypothesized that a multimodal analgesic pathway incorporating continuous interscalene blockade (ISB) provides better analgesic efficacy than both single-injection ISB and local infiltration analgesia.
This single-center, parallel, unblinded, randomized clinical trial evaluated 129 adults undergoing primary TSA. Patients were allocated to single-injection ISB, continuous ISB, or local infiltration analgesia. The primary outcome was the Overall Benefit of Analgesia Score (range, 0 [best] to 28 [worst]) on postoperative day 1. Additional outcomes included pain scores, opioid consumption, quality of life, and postoperative complications in the first 24 hours, at 3 months, and at 1 year.
We analyzed 125 patients (42 with single-injection ISB, 41 with continuous ISB, and 42 with local infiltration analgesia). The Overall Benefit of Analgesia Score was significantly improved in the continuous group (median [25th percentile, 75th percentile], 0 [0, 2]) compared with the single-injection group (2 [1, 4]; P = .002) and local infiltration analgesia group (3 [2, 4]; P < .001). Pain scores were significantly lower in the continuous group compared with the local infiltration analgesia group (P < .001 for all time points) and after 12 hours from ward arrival compared with the single-injection group (median [25th percentile, 75th percentile], 1.0 [0.0, 2.8] vs. 2.5 [0.0, 4.0]; P = .016). After postanesthesia recovery discharge, opioid consumption (oral morphine equivalents) was significantly lower in the continuous group (median [25th percentile, 75th percentile], 7.5 mg [0.0, 25.0 mg]) than in the local infiltration analgesia group (30 mg [15.0, 52.5 mg]; P < .001) and single-injection group (17.6 mg [7.5, 45.5 mg]; P = .010). No differences were found across groups for complications, 3-month outcomes, and 1-year outcomes.
Continuous ISB provides superior analgesia compared with single-injection ISB and local infiltration analgesia in the first 24 hours after TSA.
全肩关节置换术（TSA）的理想镇痛方式仍存在争议。我们假设，包含连续肌间沟阻滞（ISB）的多模式镇痛途径比单次注射 ISB 和局部浸润性镇痛提供更好的镇痛效果。
这是一项单中心、平行、非盲、随机临床试验，评估了 129 例接受初次 TSA 的成年人。患者被分配至单次注射 ISB、连续 ISB 或局部浸润性镇痛组。主要结局是术后第 1 天的总体镇痛效果评分（范围 0[最佳]至 28[最差]）。其他结局包括术后 24 小时、3 个月和 1 年时的疼痛评分、阿片类药物用量、生活质量和术后并发症。
我们分析了 125 例患者（42 例接受单次注射 ISB，41 例接受连续 ISB，42 例接受局部浸润性镇痛）。与单次注射 ISB 组（2[1,4]；P=0.002）和局部浸润性镇痛组（3[2,4]；P<0.001）相比，连续 ISB 组的总体镇痛效果评分显著提高（中位数[25 百分位数，75 百分位数]，0[0,2]）。与局部浸润性镇痛组相比，连续 ISB 组的疼痛评分在所有时间点均显著降低（所有时间点 P<0.001），且与单次注射 ISB 组相比，在术后 12 小时从病房离开时显著降低（中位数[25 百分位数，75 百分位数]，1.0[0.0,2.8] vs. 2.5[0.0,4.0]；P=0.016）。在麻醉后恢复出院时，连续 ISB 组的阿片类药物用量（口服吗啡当量）明显低于局部浸润性镇痛组（中位数[25 百分位数，75 百分位数]，7.5mg[0.0,25.0mg]）和单次注射 ISB 组（17.6mg[7.5,45.5mg]；P=0.010）。三组在并发症、3 个月结局和 1 年结局方面无差异。
与单次注射 ISB 和局部浸润性镇痛相比，连续 ISB 在 TSA 后 24 小时内提供更好的镇痛效果。
