Updegrove Gary F, Stauch Christopher M, Ponnuru Padmavathi, Kunselman Allen R, Armstrong April D
Department of Orthopedics, Penn State Hershey Medical Center, Hershey, PA, USA.
Department of Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA, USA.
JSES Int. 2020 Mar 3;4(2):357-361. doi: 10.1016/j.jseint.2019.12.007. eCollection 2020 Jun.
Optimal modalities for pain control in shoulder arthroplasty are not yet established. Although regional nerve blockade has been a well-accepted modality, complications and rebound pain have led some surgeons to seek other pain control modalities. Local injection of anesthetics has recently gained popularity in joint arthroplasty. The purpose of this study was to evaluate the effectiveness and complication rate of a low-cost local anesthetic injection mixture for use in total shoulder arthroplasty (TSA) compared with interscalene brachial plexus blockade.
A total of 314 patients underwent TSA and were administered general anesthesia with either a local injection mixture (local infiltration anesthesia [LIA], n = 161) or peripheral nerve block (PNB, n = 144). Patient charts were retrospectively reviewed for postoperative pain scores, 24-hour opioid consumption, and 90-day postoperative complications.
Immediate postoperative pain scores were not significantly different between groups ( = .94). The LIA group demonstrated a trend toward lower pain scores at 24 hours postoperatively ( = .10). Opioid consumption during the first 24 hours following surgery was significantly reduced in the LIA group compared with the PNB group ( < .0001). There was a trend toward fewer postoperative nerve and cardiopulmonary complications in the LIA group than the PNB group ( = .22 and = .40, respectively).
Periarticular local injection mixtures provide comparable pain control to regional nerve blocks while reducing opioid use and postoperative complications following TSA. Local injection of a multimodal anesthetic solution is a viable option for pain management in TSA.
肩关节置换术中疼痛控制的最佳方式尚未确立。尽管区域神经阻滞一直是一种广为接受的方式，但并发症和反弹痛促使一些外科医生寻求其他疼痛控制方式。局部注射麻醉剂最近在关节置换术中受到欢迎。本研究的目的是评估一种低成本局部麻醉剂注射混合物用于全肩关节置换术（TSA）与肌间沟臂丛神经阻滞相比的有效性和并发症发生率。
共有314例患者接受了TSA，并接受全身麻醉，其中一组采用局部注射混合物（局部浸润麻醉[LIA]，n = 161），另一组采用周围神经阻滞（PNB，n = 144）。对患者病历进行回顾性分析，以获取术后疼痛评分、24小时阿片类药物消耗量和术后90天并发症情况。
两组术后即刻疼痛评分无显著差异（P = 0.94）。LIA组术后24小时疼痛评分有降低趋势（P = 0.10）。与PNB组相比，LIA组术后24小时内阿片类药物消耗量显著减少（P < 0.0001）。LIA组术后神经和心肺并发症的发生率有低于PNB组的趋势（分别为P = 0.22和P = 0.40）。
关节周围局部注射混合物在TSA术后可提供与区域神经阻滞相当的疼痛控制，同时减少阿片类药物的使用和术后并发症。局部注射多模式麻醉溶液是TSA疼痛管理的一种可行选择。
