Boekel Pamela, Brereton Sarah G, Doma Kenji, Grant Andrea, Kippin Alex, Wilkinson Matthew, Morse Levi
Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.
Mater Health Services North Queensland, Pimlico, Townsville, Queensland, Australia.
JSES Int. 2022 Dec 22;7(2):307-315. doi: 10.1016/j.jseint.2022.12.011. eCollection 2023 Mar.
The use of regional anesthesia in shoulder arthroscopy improves perioperative pain control, thereby reducing the need for opioids and their recognized side effects. Occasionally one type of block is not suitable for a patient's anatomy or comorbidities or requires a specially trained anesthetist to safely perform. The primary aim of this study is to compare the efficacy of 3 different nerve blocks for pain management in patients undergoing shoulder arthroscopy.
A 3-arm, blinded, randomized controlled trial in patients undergoing elective, unilateral shoulder arthroscopic procedures between August 2018 and November 2020 was conducted at a single center. One hundred and thirty participants were randomized into 1 of 3 regional anesthesia techniques. The first group received an ultrasound-guided interscalene block performed by an anesthetist (US + ISB). The second group received an ultrasound-guided suprascapular nerve block and an axillary nerve block by an anesthetist (US + SSANB). The final group received a suprascapular nerve block without ultrasound and an axillary nerve block under arthroscopic guidance by an orthopedic surgeon (A + SSANB). Intraoperative pain response, analgesia requirements, and side effects were recorded. Visual analogue pain scores and opioid doses were recorded in the Post Anaesthesia Care Unit (PACU) and daily for 8 days following the procedure.
Twelve patients withdrew from the study after randomization, leaving 39 participants in US + ISB, 40 in US + SSANB, and 39 in A + SSANB. The US + ISB group required significantly lower intraoperative opioid doses than US + SSANB and A + SSANB ( < .001) and postoperatively in PACU ( < .001). After discharge from hospital, there were no differences between all groups in daily analgesia requirements ( = .063). There was significantly more nerve complications with 6 patient-reported complications in the US + ISB group ( = .02). There were no reported differences in satisfaction rates between groups ( = .41); however, the A + SSANB group was more likely to report a wish to not have a regional anesthetic again ( = .04).
The US + ISB group required lower opioid doses perioperatively; however, there was no difference between groups after discharge from PACU. The analgesia requirements between the US + SSANB and A + SSANB were similar intraoperatively and postoperatively. A surgeon-administered SSANB may be a viable alternative when an experienced regional anesthetist is not available.
在肩关节镜检查中使用区域麻醉可改善围手术期疼痛控制，从而减少对阿片类药物的需求及其公认的副作用。偶尔，一种阻滞方式可能不适用于患者的解剖结构或合并症，或者需要经过专门培训的麻醉师才能安全实施。本研究的主要目的是比较3种不同神经阻滞在肩关节镜手术患者疼痛管理中的疗效。
在2018年8月至2020年11月期间，于单一中心对接受择期单侧肩关节镜手术的患者进行了一项三臂、盲法、随机对照试验。130名参与者被随机分为3种区域麻醉技术中的一种。第一组接受麻醉师实施的超声引导下斜角肌间隙阻滞（US + ISB）。第二组接受麻醉师实施的超声引导下肩胛上神经阻滞和腋神经阻滞（US + SSANB）。最后一组接受骨科医生在关节镜引导下实施的非超声引导肩胛上神经阻滞和腋神经阻滞（A + SSANB）。记录术中疼痛反应、镇痛需求和副作用。在麻醉后护理单元（PACU）记录视觉模拟疼痛评分和阿片类药物剂量，并在术后8天每天记录。
12名患者在随机分组后退出研究，最终US + ISB组有39名参与者，US + SSANB组有40名，A + SSANB组有39名。US + ISB组术中所需阿片类药物剂量显著低于US + SSANB组和A + SSANB组（P <.001），在PACU术后也是如此（P <.001）。出院后，所有组在每日镇痛需求方面无差异（P =.063）。US + ISB组有6例患者报告的神经并发症明显更多（P =.02）。各组之间在满意度方面无报告差异（P =.41）；然而，A + SSANB组更有可能报告希望不再接受区域麻醉（P =.04）。
US + ISB组围手术期所需阿片类药物剂量较低；然而，从PACU出院后各组之间无差异。US + SSANB组和A + SSANB组在术中和术后的镇痛需求相似。当没有经验丰富的区域麻醉师时，由外科医生实施的肩胛上神经阻滞可能是一种可行的替代方法。
