在关节镜肩关节手术中，第八颈神经根阻滞在肌间沟臂丛神经阻滞时可减轻后路入路引起的疼痛，但增加霍纳综合征的发生率：一项随机对照试验。

Eighth Cervical Nerve Root Block During Interscalene Brachial Plexus Block Decreases Pain Caused by Posterior Portal Placement but Increases Horner Syndrome in Patients Undergoing Arthroscopic Shoulder Surgery: A Randomized Controlled Trial.

机构信息

Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Republic of Korea.

Department of Orthopedic Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea.

出版信息

Arthroscopy. 2024 Feb;40(2):217-228.e4. doi: 10.1016/j.arthro.2023.06.022. Epub 2023 Jun 22.

DOI:10.1016/j.arthro.2023.06.022

PMID:37355189

Abstract

PURPOSE

To compare the intensity of pain on posterior portal placement between a C5-C7 root block (conventional interscalene brachial plexus block [ISBPB]) and a C5-C8 root block in patients undergoing arthroscopic shoulder surgery.

METHODS

In this prospective, single-blinded, parallel-group randomized controlled trial, patients were randomized to receive either a C5-C7 root block (C5-C7 group, n = 37) or a C5-C8 root block (C5-C8 group, n = 36) with 25 mL of 0.75% ropivacaine. The primary outcome was the pain intensity on posterior portal placement, which was graded as 0 (no pain), 1 (mild pain), or 2 (severe pain). The secondary outcomes were the bilateral pupil diameters measured 30 minutes after ISBPB placement; the incidence of Horner syndrome, defined as a difference in pupil diameter (ipsilateral - contralateral) of less than -0.5 mm; the onset of postoperative pain; and the postoperative numerical rating pain score, where 0 and 10 represent no pain and the worst pain imaginable, respectively.

RESULTS

Fewer patients reported mild or severe pain on posterior portal placement in the C5-C8 group than in the C5-C7 group (9 of 36 [25.0%] vs 24 of 37 [64.9%], P = .003). Less pain on posterior portal placement was reported in the C5-C8 group than in the C5-C7 group (median [interquartile range], 0 [0-0.75] vs 1 [0-1]; median difference [95% confidence interval], 1 [0-1]; P = .001). The incidence of Horner syndrome was higher in the C5-C8 group than in the C5-C7 group (33 of 36 [91.7%] vs 22 of 37 [59.5%], P = .001). No significant differences in postoperative numerical rating pain scores and onset of postoperative pain were found between the 2 groups.

CONCLUSIONS

A C5-C8 root block during an ISBPB reduces the pain intensity on posterior portal placement. However, it increases the incidence of Horner syndrome with no improvement in postoperative pain compared with the conventional ISBPB (C5-C7 root block).

LEVEL OF EVIDENCE

Level I, randomized controlled trial.

摘要

目的

比较在接受关节镜肩关节手术的患者中，行 C5-C7 神经根阻滞（传统肌间沟臂丛神经阻滞[ISBPB]）与 C5-C8 神经根阻滞时，后入路置管的疼痛强度。

方法

在这项前瞻性、单盲、平行组随机对照试验中，患者被随机分为接受 25 mL 0.75%罗哌卡因的 C5-C7 神经根阻滞（C5-C7 组，n=37）或 C5-C8 神经根阻滞（C5-C8 组，n=36）。主要结局为后入路置管时的疼痛强度，分为 0 级（无痛）、1 级（轻度疼痛）或 2 级（重度疼痛）。次要结局为 ISBPB 放置后 30 分钟时双侧瞳孔直径的测量；霍纳综合征的发生率，定义为瞳孔直径差异（同侧-对侧）<0.5mm；术后疼痛发作时间；以及术后数字评分疼痛评分，其中 0 和 10 分别代表无痛和可想象的最痛。

结果

C5-C8 组报告后入路置管时轻度或重度疼痛的患者少于 C5-C7 组（36 例中的 9 例[25.0%] vs 37 例中的 24 例[64.9%]，P=.003）。C5-C8 组报告的后入路置管疼痛程度低于 C5-C7 组（中位数[四分位间距]，0 [0-0.75] vs 1 [0-1]；中位数差值[95%置信区间]，1 [0-1]；P=.001）。C5-C8 组霍纳综合征的发生率高于 C5-C7 组（36 例中的 33 例[91.7%] vs 37 例中的 22 例[59.5%]，P=.001）。两组术后数字评分疼痛评分和术后疼痛发作时间无显著差异。