Kim Jung Youn, Kang Min Wook, Lee Ho Won, Noh Kyu Cheol
Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea.
Orthop J Sports Med. 2021 Jan 22;9(1):2325967120970906. doi: 10.1177/2325967120970906. eCollection 2021 Jan.
Effective pain control in patients who have undergone arthroscopic rotator cuff surgery improves functional recovery and early mobilization. Interscalene blocks (ISBs), a widely used approach, are safe and provide fast pain relief; however, they are associated with complications. Another pain management strategy is the use of a suprascapular nerve block (SSNB).
We hypothesized that indwelling SSNB catheters are a more effective pain control method than single-shot ISBs. We also hypothesized that indwelling SSNB catheters will reduce the level of rebound pain and the demand for opioid analgesics.
Randomized controlled trial; Level of evidence, 1.
Included in this study were 93 patients who underwent arthroscopic rotator cuff surgery between May 2012 and January 2019. These patients were assigned to either the indwelling SSNB catheter group, the single-shot ISB group, or the control (sham/placebo) group (31 patients per group). Level of pain was measured with a visual analog scale (VAS; 0 to 10 [worst pain]) on the day of the operation. The preoperative VAS score was recorded at 6 AM on the day of operation, and the postoperative scores were recorded at 1, 8, and 16 hours after surgery and then every 8 hours until postoperative day 3.
The VAS pain scores were lower in the SSNB and ISB groups than in the control group up to postoperative hour (POH) 8, with the most significant difference at POH 8. At POH 1 and POH 8, the mean VAS scores for each group were 2.29 and 1.74 (SSNB), 2.59 and 2.50 (ISB), and 3.42 and 4.48 (control), respectively. VAS scores in the SSNB and ISB groups were consistently <3, compared with a mean VAS score of 3.1 ± 1.58 in the control group ( < .001). Compared with the ISB group, the SSNB group had significantly fewer side effects such as rebound pain duration as well as lower VAS scores ( < .001).
VAS scores were the lowest in the indwelling SSNB catheter group, with the most pronounced between-group difference in VAS scores at POH 8. Severity and recurring frequency of pain were lower in the indwelling SSNB catheter group than in the single-shot ISB group.
关节镜下肩袖修补术后患者的有效疼痛控制可改善功能恢复和早期活动。肌间沟阻滞（ISB）是一种广泛应用的方法，安全且能快速缓解疼痛；然而，其存在相关并发症。另一种疼痛管理策略是使用肩胛上神经阻滞（SSNB）。
我们假设留置SSNB导管是一种比单次注射ISB更有效的疼痛控制方法。我们还假设留置SSNB导管将降低疼痛反弹水平和阿片类镇痛药的需求。
随机对照试验；证据等级，1级。
本研究纳入了2012年5月至2019年1月期间接受关节镜下肩袖修补术的93例患者。这些患者被分配到留置SSNB导管组、单次注射ISB组或对照组（假手术/安慰剂组）（每组31例患者）。在手术当天用视觉模拟评分法（VAS；0至10分[最剧烈疼痛]）测量疼痛程度。术前VAS评分在手术当天上午6点记录，术后评分在术后1、8和16小时记录，然后每8小时记录一次，直至术后第3天。
在术后8小时（POH 8）之前，SSNB组和ISB组的VAS疼痛评分低于对照组，在POH 8时差异最为显著。在POH 1和POH 8时，每组的平均VAS评分分别为2.29和1.74（SSNB组）、2.59和2.50（ISB组）以及3.42和4.48（对照组）。SSNB组和ISB组的VAS评分始终<3分，而对照组的平均VAS评分为3.1±1.58分（P<0.001）。与ISB组相比，SSNB组的副作用如疼痛反弹持续时间明显更少，VAS评分也更低（P<0.001）。
留置SSNB导管组的VAS评分最低，在POH 8时组间VAS评分差异最为明显。留置SSNB导管组的疼痛严重程度和复发频率低于单次注射ISB组。
