Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri.
Department of Anesthesiology, University of Missouri, Columbia, Missouri.
J Bone Joint Surg Am. 2022 Oct 5;104(19):1730-1737. doi: 10.2106/JBJS.22.00034. Epub 2022 Jul 1.
While providing effective analgesia following shoulder arthroplasty, an interscalene block has known complications. Local infiltration analgesia (LIA) using ropivacaine has been successfully employed in other joint arthroplasties, but its efficacy in shoulder arthroplasty has not been studied extensively. The purpose of this study was to compare pain and opioid consumption between LIA and an interscalene block following shoulder arthroplasty.
Patients undergoing primary shoulder arthroplasty were prospectively randomized into 2 groups: the block group received an interscalene block using liposomal bupivacaine, and the injection group received an LIA injection intraoperatively. The LIA injection included ropivacaine, epinephrine, ketorolac, and normal saline solution. Postoperative visual analog scale pain scores, opioid consumption in morphine milligram equivalents, and complications were compared between the groups. The mean pain scores during the first 24 hours postoperatively were used to test noninferiority of LIA compared with an interscalene block.
The study included 74 patients (52 men and 22 women with a mean age of 69 years; 37 were in the injection group and 37 in the block group). There was no significant difference between the groups with respect to pain scores at any postoperative time points (p > 0.05), except for the 8-hour time point, when the injection group had a significantly higher pain score than the block group (p = 0.01). There was no significant difference in opioid consumption between the groups at any time points postoperatively (p > 0.05). The amount of intraoperative opioid consumption was significantly higher in the injection group (p < 0.001). In noninferiority testing for the mean pain scores during the first 24 hours, the injection group was found to be noninferior to the block group. One patient in the block group developed transient phrenic nerve palsy. One patient in the injection group developed dislocation after reverse arthroplasty related to noncompliance. The mean procedure hospital charge was $1,718 for an interscalene block and $157 for LIA.
LIA and an interscalene block provided similar analgesia during the first 24 hours after primary shoulder arthroplasty. LIA was associated with worse pain at 8 hours postoperatively and more intraoperative opioid consumption but was also substantially less costly.
Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
在肩关节置换术后提供有效镇痛的同时，膈神经阻滞有其已知的并发症。罗哌卡因局部浸润镇痛（LIA）已成功应用于其他关节置换术，但在肩关节置换术中的效果尚未得到广泛研究。本研究旨在比较肩关节置换术后 LIA 与膈神经阻滞的疼痛和阿片类药物消耗。
前瞻性随机将接受初次肩关节置换术的患者分为 2 组：阻滞组接受脂质体布比卡因的膈神经阻滞，注射组在术中接受 LIA 注射。LIA 注射包括罗哌卡因、肾上腺素、酮咯酸和生理盐水。比较两组患者术后视觉模拟评分疼痛评分、吗啡毫克当量消耗的阿片类药物和并发症。使用术后 24 小时内的平均疼痛评分来测试 LIA 与膈神经阻滞的非劣效性。
研究纳入 74 例患者（52 名男性和 22 名女性，平均年龄 69 岁；37 例患者在注射组，37 例在阻滞组）。除 8 小时时间点外，两组患者在任何术后时间点的疼痛评分均无显著差异（p>0.05），在 8 小时时间点，注射组的疼痛评分明显高于阻滞组（p=0.01）。两组患者在术后任何时间点的阿片类药物消耗均无显著差异（p>0.05）。注射组术中阿片类药物消耗明显较高（p<0.001）。在术后 24 小时内的平均疼痛评分非劣效性检验中，注射组被发现与阻滞组相当。阻滞组 1 例患者出现短暂性膈神经麻痹。注射组 1 例患者因反肩关节置换术后不遵医嘱而发生脱位。膈神经阻滞的平均手术医院费用为 1718 美元，LIA 为 157 美元。
LIA 和膈神经阻滞在初次肩关节置换术后的前 24 小时内提供了相似的镇痛效果。LIA 术后 8 小时疼痛更严重，术中阿片类药物消耗更多，但成本也显著降低。
治疗水平 I. 有关证据水平的完整描述，请参见作者说明。
