Ouryouji Orthopaedic Hospital, Kobayashi, Japan.
J Shoulder Elbow Surg. 2020 Jul;29(7):1310-1315. doi: 10.1016/j.jse.2020.03.004.
We investigated the effectiveness of cocktail therapy after arthroscopic rotator cuff repair (ARCR).
We evaluated 128 shoulders undergoing ARCR and used block randomization to divide patients into 2 groups in this double-blind trial: The cocktail group received 20 mL of 0.75% ropivacaine, 5 mg of morphine, 0.3 mg of epinephrine, 2 mg of betamethasone, and saline solution to a total of 42 mL, whereas the control group received 20 mL of 0.75% ropivacaine and saline solution to a total of 42 mL. Postoperatively, one of the drug mixtures was injected into the glenohumeral joint, subacromial bursa, suprascapular nerve, and anterior, middle, and posterior parts of the deltoid muscle according to the treatment group. We recorded patients' visual analog scale scores preoperatively and at 4, 8, 16, 24, and 48 hours postoperatively; the number of patients using postoperative diclofenac suppositories and buprenorphine hydrochloride; the number of patients experiencing nausea; the number of patients with infection and delayed wound healing as adverse effects; the surgery time; the retear rate; and passive shoulder range of motion.
The cocktail group constituted 64 shoulders (50.0%), with 39 men (60.9%) and 25 women (39.1%); the mean age was 64.2 ± 10.2 years. The control group constituted 64 shoulders (50.0%), with 41 men (64.1%) and 23 women (35.9%); the mean age was 65.2 ± 7.5 years. We found no significant difference in age or sex between the 2 groups. There was also no significant difference in rotator cuff tear size or surgery time between the 2 groups. The visual analog scale scores at 8, 16, and 24 hours postoperatively were significantly lower in the cocktail group. The number of patients using suppositories was also significantly lower in the cocktail group. The number of patients receiving buprenorphine injections tended to be lower in the cocktail group, but the difference was not significant. Nausea occurred in 6.3% of patients in the cocktail group and 15.6% in the control group, but the difference was not significant. No infection or delayed wound healing occurred in either group. There was no significant difference in the retear rate between the 2 groups. Passive anterior elevation at 3 months postoperatively was significantly better in the cocktail group than in the control group.
We compared cocktail therapy and ropivacaine after ARCR and found no difference in results except for VAS score at 8, 16, and 24 hours postoperatively and frequency of postoperative suppository use without an apparent risk of infection or a detrimental effect on tendon healing.
我们研究了关节镜下肩袖修复（ARCR）后鸡尾酒疗法的效果。
我们评估了 128 例接受 ARCR 的肩部，并在这项双盲试验中使用区组随机化将患者分为 2 组：鸡尾酒组接受 20 毫升 0.75%罗哌卡因、5 毫克吗啡、0.3 毫克肾上腺素、2 毫克倍他米松和生理盐水，共 42 毫升，而对照组接受 20 毫升 0.75%罗哌卡因和生理盐水，共 42 毫升。术后，根据治疗组将其中一种药物混合物注射到盂肱关节、肩峰下囊、肩胛上神经以及三角肌的前、中、后部位。我们记录了患者术前和术后 4、8、16、24 和 48 小时的视觉模拟评分（VAS）；使用术后双氯芬酸钠栓剂和盐酸丁丙诺啡的患者人数；出现恶心的患者人数；出现感染和伤口愈合延迟等不良反应的患者人数；手术时间；再撕裂率；以及被动肩部活动范围。
鸡尾酒组有 64 例（50.0%），其中 39 例为男性（60.9%），25 例为女性（39.1%）；平均年龄为 64.2 ± 10.2 岁。对照组有 64 例（50.0%），其中 41 例为男性（64.1%），23 例为女性（35.9%）；平均年龄为 65.2 ± 7.5 岁。我们发现两组之间在年龄或性别方面没有显著差异。两组之间肩袖撕裂的大小或手术时间也没有显著差异。术后 8、16 和 24 小时，鸡尾酒组的 VAS 评分明显更低。使用栓剂的患者数量在鸡尾酒组也明显减少。在鸡尾酒组中，接受丁丙诺啡注射的患者数量也倾向于减少，但差异无统计学意义。鸡尾酒组有 6.3%的患者出现恶心，对照组有 15.6%的患者出现恶心，但差异无统计学意义。两组均未发生感染或伤口愈合延迟。两组的再撕裂率无显著差异。术后 3 个月时，鸡尾酒组的被动前举明显优于对照组。
我们比较了关节镜下肩袖修复后鸡尾酒疗法和罗哌卡因的疗效，除了术后 8、16 和 24 小时的 VAS 评分和术后使用栓剂的频率外，结果没有差异，且无感染或对肌腱愈合产生不利影响的明显风险。
