经锁骨上路与经胸廓锁前入路阻滞在关节镜肩关节手术中随机比较：一项非劣效性研究。
Randomised comparison between superior trunk and costoclavicular blocks for arthroscopic shoulder surgery: A noninferiority study.
机构信息
From the Department of Anaesthesiology and Pain Medicine (YJ, CO, JP, Y-HK, YK, WC, BH), Department of Orthopaedic surgery, Chungnam National University Hospital, College of Medicine (W-YL, H-JC) and Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea (YK, BH).
出版信息
Eur J Anaesthesiol. 2022 Oct 1;39(10):810-817. doi: 10.1097/EJA.0000000000001735. Epub 2022 Aug 17.
BACKGROUND
Superior trunk block (STB) provides noninferior analgesia to the interscalene block and reduces the risk of hemidiaphragmatic paralysis (HDP). Recently, supraclavicular spreading has also been shown to occur during costoclavicular block (CCB), presenting as an alternative analgesic technique for shoulder surgery.
OBJECTIVE
The aim of this study was to determine whether there is a difference in postoperative pain scores and HDP incidence between STB and CCB.
DESIGN
Prospective randomised controlled trial.
SETTING
Chungnam National University Hospital in Daejeon from January to July 2021.
PATIENTS
Seventy patients, aged 20 to 70 years with ASA Physical Status classifications I to III and scheduled for elective arthroscopic rotator cuff repair were recruited.
INTERVENTION
Ultrasound-guided STB or CCB was performed with 20 ml 0.5% ropivacaine.
MAIN OUTCOME MEASURES
The primary outcome was the pain score (numeric rating scale, NRS) at 1 h postsurgery. A 1.4 (NRS) noninferiority margin was set a priori . The incidence of HDP, postoperative change of pulmonary function and postoperative opioid use were included as secondary outcomes.
RESULTS
The pain score was higher in the CCB group compared with the STB group at 1 h postoperatively (median difference, 2; 95% confidence interval (CI), 1 to 3; noninferiority was not demonstrated). Two patients in the CCB group received a rescue interscalene block due to severe postoperative pain. The incidence of complete HDP was lower in the CCB group (risk difference, -26%; 95% CI, -6 to -45%; P < 0.001). The median reduction in forced vital capacity and forced expiratory volume in 1 s were also significantly lower in the CCB group.
CONCLUSION
Although the incidence of HDP was lower, CCB did not show noninferiority in immediate postoperative analgesia compared with STB in arthroscopic shoulder surgery.
CLINICAL TRIAL REGISTRATION
Clinical Trial Registry of Korea (KCT0005822, principal investigator: Boohwi Hong) on 25 January 2021 ( https://cris.nih.go.kr ).
背景
与肌间沟阻滞相比，锁骨上路阻滞（STB）提供了非劣效的镇痛效果，并降低了膈神经麻痹（HDP）的风险。最近，锁骨下扩散也已被证明发生在肋锁间隙阻滞（CCB）期间，为肩部手术提供了一种替代的镇痛技术。
目的
本研究旨在确定 STB 和 CCB 之间在术后疼痛评分和 HDP 发生率方面是否存在差异。
设计
前瞻性随机对照试验。
地点
大田钟南国立大学医院，2021 年 1 月至 7 月。
患者
70 名年龄在 20 至 70 岁之间，ASA 身体状况分类 I 至 III 级，择期行关节镜下肩袖修复术的患者入选。
干预
超声引导下进行 STB 或 CCB，注射 20ml 0.5%罗哌卡因。
主要观察指标
主要结局是术后 1 小时的疼痛评分（数字评分量表，NRS）。预先设定了 1.4（NRS）的非劣效性边界。HDP 的发生率、术后肺功能变化和术后阿片类药物使用情况被纳入次要结局。
结果
与 STB 组相比，CCB 组术后 1 小时的疼痛评分更高（中位数差值，2；95%置信区间（CI），1 至 3；未证明非劣效性）。2 名 CCB 组患者因术后严重疼痛接受了补救性肌间沟阻滞。CCB 组完全 HDP 的发生率较低（风险差异，-26%；95%CI，-6 至-45%；P ＜0.001）。CCB 组用力肺活量和 1 秒用力呼气量的中位数降低也更为显著。
结论
尽管膈神经麻痹的发生率较低，但与 STB 相比，CCB 在关节镜肩部手术中并未显示出即时术后镇痛的非劣效性。
临床试验注册
韩国临床试验注册中心（KCT0005822，主要研究者：Boohwi Hong）于 2021 年 1 月 25 日注册（https://cris.nih.go.kr）。
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