右美托咪定联合肌间沟臂丛神经阻滞对关节镜下肩袖修复术后疼痛缓解具有协同作用。
Dexmedetomidine combined with interscalene brachial plexus block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair.
机构信息
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea.
Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2020 Jul;28(7):2343-2353. doi: 10.1007/s00167-019-05799-3. Epub 2019 Nov 26.
PURPOSE
Interscalene brachial plexus block (ISB) is one of the most commonly used regional blocks in relieving postoperative pain after arthroscopic rotator cuff repair. Dexmedetomidine (DEX) is an alpha 2 agonist that can enhance the effect of regional blocks. The aim of this study was to compare the effects of DEX combined with ISB with ISB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair.
METHODS
Fifty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single center, double-blinded randomized controlled trial study. Twenty-five patients were randomly allocated to group 1 and received ultrasound-guided ISB using a mixture of 1 ml (100 μg) of DEX and 8 ml of 0.75% ropivacaine preemptively. The other 25 patients were allocated to group 2 and underwent ultrasound-guided ISB alone using a mixture of 1 ml of normal saline and 8 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were checked within 48 h postoperatively. The plasma interleukin (IL)-6, -8, -1β, cortisol, and substance P levels were also measured within 48 h, postoperatively.
RESULTS
Group 1 showed a significantly lower mean VAS score and a significantly higher mean SAT score than group 2 at 1, 3, 6, 12, and 18 h postoperatively. Compared with group 2, group 1 showed a significantly lower mean plasma IL-6 level at 1, 6, 12, and 48 h postoperatively and a significantly lower mean IL-8 level at 1, 6, 12, 24, and 48 h postoperatively. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (12.7 h > 9.4 h, p = 0.006).
CONCLUSIONS
Ultrasound-guided ISB with DEX in arthroscopic rotator cuff repair led to a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h postoperatively than ISB alone. In addition, ISB with DEX showed lower mean plasma IL-6 and IL-8 levels than ISB alone within 48 h postoperatively, with delayed rebound pain.
LEVEL OF EVIDENCE
I.
TRIAL REGISTRATION
2013-112, ClinicalTrials.gov Identifier: NCT02766556.
目的
经肌间沟臂丛神经阻滞（ISB）是缓解关节镜肩袖修复术后疼痛的最常用区域阻滞方法之一。右美托咪定（DEX）是一种α2 受体激动剂，可增强区域阻滞的效果。本研究旨在比较DEX 联合 ISB 与 ISB 单独用于关节镜肩袖修复术后 48 小时内的术后疼痛、满意度和与疼痛相关的细胞因子的效果。
方法
本单中心、双盲随机对照试验研究纳入了 50 例接受关节镜肩袖修复术的肩袖撕裂患者。25 例患者随机分配至 1 组，接受超声引导下 ISB，使用 1ml（100μg）DEX 和 8ml 0.75%罗哌卡因混合物进行预注。另 25 例患者被分配至 2 组，接受超声引导下 ISB，使用 1ml 生理盐水和 8ml 罗哌卡因混合物进行单独阻滞。术后 48 小时内检查视觉模拟评分（VAS）疼痛和患者满意度（SAT）评分。术后 48 小时内还测量了血浆白细胞介素（IL）-6、-8、-1β、皮质醇和 P 物质水平。
结果
术后 1、3、6、12 和 18 小时，1 组的平均 VAS 评分明显低于 2 组，平均 SAT 评分明显高于 2 组。与 2 组相比，1 组术后 1、6、12 和 48 小时的平均血浆 IL-6 水平明显较低，术后 1、6、12、24 和 48 小时的平均 IL-8 水平明显较低。1 组的平均反弹疼痛发生时间明显晚于 2 组（12.7h>9.4h，p=0.006）。
结论
与单独 ISB 相比，超声引导下 ISB 联合 DEX 用于关节镜肩袖修复术后 48 小时内可显著降低平均 VAS 评分和提高平均 SAT 评分。此外，与单独 ISB 相比，DEX 联合 ISB 在术后 48 小时内可降低平均血浆 IL-6 和 IL-8 水平，并延迟反弹疼痛。
证据水平
I。
试验注册
2013-112，ClinicalTrials.gov 标识符：NCT02766556。
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