Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Pain Res Manag. 2022 Dec 26;2022:2010224. doi: 10.1155/2022/2010224. eCollection 2022.
Despite the clinical effectiveness of the programmed intermittent bolus (PIB) method for epidural analgesia, evidence for this method in continuous interscalene brachial plexus block (CIBPB) is unclear. This study aimed to investigate the pain relief effect after arthroscopic shoulder surgery according to the administration method by comparing the PIB and continuous infusion methods among the administration methods of local anesthetics.
Sixty-four patients aged >19 years scheduled for elective arthroscopic shoulder surgery were enrolled and divided into two groups. Ultrasound-guided CIBPB was performed to control postoperative pain. The infusion pump was programmed so that 0.2% ropivacaine was continuously injected at 1.1 mL/h in group A, whereas in group B, 0.1 mL/h was continuously injected and 4 mL was periodically injected at 4 h intervals. In both groups, a further infusion of 4 mL of 0.2% ropivacaine was administered if the patient requested additional analgesia, and the lockout time was set at 30 min. Postoperative pain quality was assessed using a visual analog scale (VAS), and the incidence of patients requiring additional analgesics, motor blockade using a modified Bromage scale (MBS), and consumed doses of local anesthetic were assessed.
The VAS and incidence of rescue analgesics were performed when the patient could communicate voluntarily after admission to the post-anesthetic care unit, and at 24 and 48 h after surgery showed no significant difference between the two groups. The MBS at 24 h after surgery was significantly higher in group B ( = 0.038). In the comparison of consumed doses of local anesthetic, group B had a significantly higher bolus injection dose ( = 0.047) and frequency of bolus use in the 24 h after surgery ( = 0.034).
The PIB method in CIBPB after arthroscopic shoulder surgery provided a similar analgesic effect, with a higher bolus injection dose of local anesthetic and increased motor blockade than the continuous infusion method.
尽管硬膜外镇痛的程序化间歇推注（PIB）方法具有临床效果，但在连续肌间沟臂丛阻滞（CIBPB）中，该方法的证据尚不清楚。本研究旨在通过比较局部麻醉剂给药方法中的 PIB 和连续输注方法，根据给药方法来研究关节镜肩关节手术后的镇痛效果。
纳入 64 名年龄大于 19 岁的择期行关节镜肩关节手术的患者，并将其分为两组。超声引导下进行 CIBPB 以控制术后疼痛。输液泵编程为组 A 以 1.1 mL/h 的速度持续输注 0.2%罗哌卡因，而组 B 以 0.1 mL/h 的速度持续输注，并每 4 小时周期性输注 4 mL。在两组中，如果患者要求额外镇痛，均给予 4 mL 0.2%罗哌卡因的进一步输注，且锁定时间设为 30 min。使用视觉模拟评分法（VAS）评估术后疼痛质量，并评估需要额外镇痛药物的患者比例、改良 Bromage 量表（MBS）评估的运动阻滞程度和局部麻醉剂的使用剂量。
当患者可以在进入麻醉后护理单元后自愿交流时、术后 24 和 48 h 时进行 VAS 和需要解救镇痛药物的发生率评估，两组之间无显著差异。术后 24 h 的 MBS 在组 B 中显著较高（ = 0.038）。在局部麻醉剂使用剂量的比较中，组 B 在术后 24 h 时的推注剂量（ = 0.047）和推注使用频率更高（ = 0.034）。
关节镜肩关节手术后 CIBPB 中的 PIB 方法提供了相似的镇痛效果，但局部麻醉剂的推注剂量更高，且与连续输注方法相比，运动阻滞的发生率更高。
