Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Jun 1;84(6):640-643. doi: 10.1097/JCMA.0000000000000537.
The optimal postoperative analgesia after open rotator cuff repair surgery remains unclear. This study compared the use of a multimodal pain regimen including periarticular injection (PAI), with a control condition. We hypothesized that PAI leads to decreased opioid consumption and lower pain scores.
The perioperative analgesic regimen was standardized and implemented from January 1, 2017 to December 31, 2017. The PAI was administered from July 1, 2017 to December 31, 2017. The historical control group was enrolled from January 1, 2017 to June 30, 2017. The evaluation items included assessments of pain using a 10-point visual analog scale (VAS) before and after the mini-open rotator cuff repair and on postoperative days 1, 2, and 3. The dose of ketorolac suppository and its side effects were also evaluated.
The VAS score on the day of the operation was significantly low in the PAI group and less incidence of night pain. The time point of the rescue drug was longer in the PAI group than the control group (12.7 hours vs. 0.62 hours; p < 0.01). No cardiac or central nervous system toxicity was observed.
In our study, PAI in the shoulder after mini-open rotator cuff repair showed effective pain control on the day of the surgery, postponed the time of the first dosage of intravenous pain medication, and reduced the total dosage of the intravenous pain medication.
开放式肩袖修复术后的最佳术后镇痛效果仍不明确。本研究比较了多模式疼痛管理方案(包括关节周围注射)与对照组的使用效果。我们假设关节周围注射可减少阿片类药物的使用量和降低疼痛评分。
从 2017 年 1 月 1 日至 12 月 31 日,标准化并实施围手术期镇痛方案。从 2017 年 7 月 1 日至 12 月 31 日,实施关节周围注射。历史对照组纳入时间为 2017 年 1 月 1 日至 6 月 30 日。评估项目包括微型开放式肩袖修复前后和术后第 1、2、3 天的 10 分制视觉模拟评分(VAS)评估,还评估了酮咯酸栓剂的剂量及其副作用。
关节周围注射组患者的手术当天 VAS 评分明显较低,夜间疼痛发生率较低。与对照组相比,关节周围注射组患者的急救药物时间点更长(12.7 小时比 0.62 小时;p < 0.01)。未观察到心脏或中枢神经系统毒性。
在我们的研究中,微型开放式肩袖修复术后肩部的关节周围注射在手术当天表现出有效的疼痛控制,推迟了首次静脉疼痛药物剂量的时间,并减少了静脉疼痛药物的总剂量。