Iwashita Satoshi, Hashiguchi Hiroshi, Okubo Atsushi, Yoneda Minoru, Takai Shinro
Department of Orthopaedic Surgery, Nippon Medical School Hospital.
J Nippon Med Sch. 2020 May 15;87(2):87-91. doi: 10.1272/jnms.JNMS.2020_87-206. Epub 2020 Jan 31.
Although arthroscopic rotator cuff repair (ARCR) often results in good outcomes, some patients have severe pain postoperatively. This study investigated the efficacy of nerve block for ARCR.
This study was retrospective, and consent was obtained from all patients. We divided 50 patients who had undergone ARCR into 4 groups: continuous interscalene nerve block was performed for 11 patients (continuous-injection group), single interscalene nerve block for 10 (single-injection group), suprascapular nerve block for 8 (suprascapular group), and intravenous analgesic administration for 10 (intravenous group). Eleven patients received no nerve block (control group). We evaluated diclofenac sodium and pentazocine dosing, visual analog scale (VAS) scores, and perioperative complications in each group. VAS scoring was done immediately after surgery and 1 and 6 hours and 1, 2, 3, 7, and 14 days postoperatively.
The doses of diclofenac sodium and pentazocine did not differ between groups. VAS scores immediately after surgery and at 1 and 6 hours after surgery were significantly lower in the single-injection and continuous-injection groups than in the suprascapular, intravenous, and control groups. VAS score at 1 day postoperatively was significantly lower in the continuous-injection group than in the other groups. One patient in the continuous group reported temporary paralysis of the fingers and drug solution leakage.
Interscalene nerve blocks yielded good pain relief for ARCR. Although continuous interscalene nerve block produced continuous pain relief, complications are a concern.
尽管关节镜下肩袖修复术（ARCR）通常能取得良好效果，但部分患者术后仍有严重疼痛。本研究调查了神经阻滞用于ARCR的疗效。
本研究为回顾性研究，所有患者均获得同意。我们将50例行ARCR的患者分为4组：11例患者接受连续肌间沟神经阻滞（连续注射组），10例接受单次肌间沟神经阻滞（单次注射组），8例接受肩胛上神经阻滞（肩胛上神经组），10例接受静脉镇痛给药（静脉组）。11例患者未接受神经阻滞（对照组）。我们评估了每组双氯芬酸钠和喷他佐辛的用量、视觉模拟评分（VAS）以及围手术期并发症。术后立即、术后1小时、6小时以及术后1天、2天、3天、7天和14天进行VAS评分。
各组双氯芬酸钠和喷他佐辛的用量无差异。单次注射组和连续注射组术后立即、术后1小时和6小时的VAS评分显著低于肩胛上神经组、静脉组和对照组。连续注射组术后1天的VAS评分显著低于其他组。连续组有1例患者报告手指暂时麻痹和药物溶液渗漏。
肌间沟神经阻滞对ARCR有良好的镇痛效果。尽管连续肌间沟神经阻滞能持续缓解疼痛，但并发症仍需关注。
