Department of Anaesthesiology, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, DK-3400, Hillerød, Denmark.
Department of Anaesthesiology, Aleris-Hamlet Hospital, Copenhagen, Denmark.
BMC Anesthesiol. 2020 Jan 31;20(1):33. doi: 10.1186/s12871-020-0952-y.
The sensory innervation of the shoulder is complex and there are variations in the branching patterns of the sensory fibres. Articular branches from the axillary nerve to the subacromial bursa are described in more than 50% of investigated shoulders but the isolated contribution of sensory input from the axillary nerve has never been investigated clinically. We hypothesized that a selective block of the axillary nerve would reduce morphine consumption and pain after arthroscopic subacromial decompression.
We included 60 patients in a randomized, blinded, placebo-controlled study. Patients were randomized to a preoperative selective ultrasound-guided axillary nerve block with 20 mL ropivacaine (7.5 mg/mL) or 20 mL saline. Primary outcome was intravenous morphine consumption 0-4 h postoperatively. Secondary outcome was postoperative pain evaluated by a visual analogue scale (VAS) score (0-100).
We analysed data from 50 patients and found no significant difference in 0-4 h postoperative morphine consumption between the two groups (ropivacaine 14 mg, placebo 18 mg (P = 0.12)). There was a reduction in postoperative pain: VAS 0-4 h (area under the curve) (ropivacaine 135, placebo 182 (P = 0.03)), VAS after 8 h (ropivacaine 9, placebo 20 (P = 0.01)) and VAS after 24 h (ropivacaine 7, placebo 18 (P = 0.04)). Eight out of 19 patients with a successful selective axillary nerve block needed an interscalene brachial plexus escape block.
Selective block of the axillary nerve has some pain relieving effect, but in this setting the effect was unpredictable, variable and far from sufficient in a large proportion of the patients.
ClinicalTrials.gov (NCT01463865). Registered: November 1, 2011.
肩部的感觉神经支配非常复杂，感觉纤维的分支模式存在差异。在 50%以上研究的肩部中，腋神经到肩峰下囊的关节支被描述为存在，但腋神经的感觉传入的单独贡献从未在临床上进行过研究。我们假设选择性腋神经阻滞会减少关节镜下肩峰下减压术后的吗啡消耗和疼痛。
我们将 60 例患者纳入一项随机、盲法、安慰剂对照研究。患者被随机分为术前超声引导下选择性腋神经阻滞组（20ml 罗哌卡因 7.5mg/ml）或 20ml 生理盐水组。主要结局为术后 0-4 小时静脉内吗啡消耗量。次要结局为术后视觉模拟评分（VAS）（0-100）评估的疼痛。
我们分析了 50 例患者的数据，发现两组患者术后 0-4 小时吗啡消耗量无显著差异（罗哌卡因 14mg，安慰剂 18mg（P=0.12））。术后疼痛减轻：0-4 小时 VAS（曲线下面积）（罗哌卡因 135，安慰剂 182（P=0.03））、8 小时后 VAS（罗哌卡因 9，安慰剂 20（P=0.01））和 24 小时后 VAS（罗哌卡因 7，安慰剂 18（P=0.04））。19 例选择性腋神经阻滞成功的患者中有 8 例需要行肌间沟臂丛神经阻滞。
选择性腋神经阻滞具有一定的止痛效果，但在这种情况下，效果不可预测、多变，且在很大一部分患者中远远不够。
ClinicalTrials.gov（NCT01463865）。注册日期：2011 年 11 月 1 日。
