Özkan Derya, Cemaloğlu Sevtap, Catma Faruk Mehmet, Akkaya Taylan
Department of Anesthesiology and Reanimation, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Department of Orthopedics and Traumatology, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Agri. 2020 Jan;32(1):1-7. doi: 10.14744/agri.2019.04875.
This study aims to investigate the effects of suprascapular nerve and axillary nerve block on postoperative pain, tramadol consumption, sevoflurane consumption and visual clarity of the surgical field in arthroscopic shoulder surgery.
Forty-six patients undergoing arthroscopic shoulder surgery were randomized to receive either both suprascapular and axillary nerve block with ultrasound guidance (20 ml 0.25% bupivacaine) before general anesthesia (group SSAXB, n=23) or a subacromial local infiltration (20 ml 0.25% bupivacaine) after the procedure (group control, n=23). End-tidal sevoflurane consumption, visualization of the arthroscopic field scores of the patients were recorded during the procedure. The patient's postoperative pain scores (at PACU, 4, 8, 12, 24 hours after the surgery) and tramadol consumption were also recorded.
End-tidal sevoflurane concentration values were similar in both groups (p>0.05). Group SSAXB had a better mean static pain score in the PACU (Group SSAXB 4.27±1.48 vs Group C 6.24±1.09 p<0.05). Tramadol consumption was lower in group SSAXB than in group C (253.1±85.3 mg vs 324.2±72 mg, p=0.005). Visual clarity scores of the arthroscopic field were higher in group SSAXB than in group C along the intraoperative period (p<0.05).
SSAXB are effective in postoperative analgesia, reduce tramadol consumption and provide a clean image in the arthroscopic area of arthroscopic shoulder surgery, but these blocks do not reduce sevoflurane consumption.
本研究旨在探讨肩胛上神经和腋神经阻滞对关节镜下肩部手术术后疼痛、曲马多用量、七氟醚用量及手术视野清晰度的影响。
46例行关节镜下肩部手术的患者被随机分为两组，一组在全身麻醉前接受超声引导下的肩胛上神经和腋神经联合阻滞（20毫升0.25%布比卡因）（SSAXB组，n = 23），另一组在手术后接受肩峰下局部浸润（20毫升0.25%布比卡因）（对照组，n = 23）。记录术中患者的呼气末七氟醚用量、关节镜视野评分。同时记录患者术后疼痛评分（在麻醉后恢复室、术后4、8、12、24小时）及曲马多用量。
两组呼气末七氟醚浓度值相似（p>0.05）。SSAXB组在麻醉后恢复室的平均静态疼痛评分更好（SSAXB组4.27±1.48 vs C组6.24±1.09，p<0.05）。SSAXB组的曲马多用量低于C组（253.1±85.3毫克 vs 324.2±72毫克，p = 0.005）。在术中，SSAXB组关节镜视野的清晰度评分高于C组（p<0.05）。
肩胛上神经和腋神经联合阻滞在关节镜下肩部手术中术后镇痛有效，可减少曲马多用量，并在关节镜区域提供清晰视野，但这些阻滞不能减少七氟醚用量。
