Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
Department of Orthopedics and Traumatology, Private Ortadogu Hospital, Ankara, Turkey
Turk J Med Sci. 2021 Jun 28;51(3):1317-1323. doi: 10.3906/sag-2008-57.
BACKGROUND/AIM: The aim of this study was to compare the effects of local infiltration analgesia and interscalene brachial plexus block techniques on postoperative pain control and shoulder functional scores in patients undergoing arthroscopic rotator cuff repair.
Sixty patients who underwent arthroscopic rotator cuff repair were prospectively included in the study. Patients were randomly divided into two groups. Group 1 was comprised of patients who had interscalene brachial plexus block, while group 2 was comprised of patients who had local infiltration analgesia. In group 1, interscalene block was applied with 20 mL 0.5% bupivacaine. In group 2, the Ranawat cocktail was used for local infiltration analgesia. Sixty milliliters of Ranawat cocktail was applied to the subacromial space and glenohumeral joint in equal amounts. Postoperative pain was assessed by the VAS score. Functional scores of the shoulder were also evaluated by Constant–Murley and UCLA scores. The time of first analgesic requirement and total analgesic consumption in the postoperative period were assessed.
The first analgesic requirement was significantly late in the interscalene brachial plexus block group (p = 0.000). There was no statistically significant difference between the groups in terms of total analgesic consumption (p = 0.204). In the postoperative 6th h, the VAS score was 2.43 in the interscalene brachial plexus block group, whereas 2.86 in the local infiltration analgesia group (p = 0.323). There was no statistically significant difference between the groups in terms of Constant–Murley shoulder and UCLA scores in the 3rd postoperative month (respectively, p = 0.929, p = 0.671). Besides, postoperative VAS scores and functional scores were negatively correlated (p < 0.01).
Local infiltration analgesia is an effective alternative to interscalene brachial plexus block for postoperative pain management and total analgesic consumption in arthroscopic rotator cuff repair. However, the interscalene brachial plexus block provides a longer postoperative painless period.
背景/目的：本研究旨在比较局部浸润镇痛和肌间沟臂丛神经阻滞技术对关节镜下肩袖修复术后疼痛控制和肩部功能评分的影响。
前瞻性纳入 60 例接受关节镜下肩袖修复术的患者。患者随机分为两组。组 1 为肌间沟臂丛神经阻滞组，组 2 为局部浸润镇痛组。组 1 采用 20mL0.5%布比卡因行肌间沟阻滞。组 2 采用 Ranawat 鸡尾酒行局部浸润镇痛。60mL Ranawat 鸡尾酒等量应用于肩峰下间隙和盂肱关节。术后采用视觉模拟评分（VAS）评估疼痛，采用 Constant–Murley 和 UCLA 评分评估肩部功能评分。评估术后首次镇痛需求时间和术后期间总镇痛消耗。
肌间沟臂丛神经阻滞组首次镇痛需求时间明显延迟（p = 0.000）。两组总镇痛消耗无统计学差异（p = 0.204）。术后 6h，肌间沟臂丛神经阻滞组 VAS 评分为 2.43，局部浸润镇痛组为 2.86（p = 0.323）。术后 3 个月两组 Constant–Murley 肩部和 UCLA 评分无统计学差异（分别为 p = 0.929、p = 0.671）。此外，术后 VAS 评分与功能评分呈负相关（p < 0.01）。
局部浸润镇痛是关节镜下肩袖修复术后疼痛管理和总镇痛消耗的有效替代肌间沟臂丛神经阻滞方法。然而，肌间沟臂丛神经阻滞提供了更长的术后无痛期。
