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全身麻醉与联合肌间沟神经/颈浅丛阻滞在关节镜下肩袖修复术中的应用:一项随机前瞻性对照试验。

General anesthesia versus combined interscalene nerve/superficial cervical plexus block in arthroscopic rotator cuff repair: A randomized prospective control trial.

机构信息

Department of Anesthesiology, Training and Research Hospital, Nigde, Turkey.

Department of Anesthesiology, Ömer Halisdemir University Faculty of Medicine, Nigde, Turkey.

出版信息

Medicine (Baltimore). 2023 Oct 20;102(42):e35522. doi: 10.1097/MD.0000000000035522.

Abstract

BACKGROUND

In this study, interscalene brachial plexus block (ISB) with superficial cervical plexus block added and general anesthesia (GA) application were evaluated in terms of intraoperative hemodynamics, operative time and postoperative analgesia need in patients who underwent rotator cuff tear repair.

METHODS

70 patients aged between 18 and 75 years were included in this prospective study. Arthroscopic rotator cuff tear repair surgery was performed in all patients. The patients were randomized into 2 groups, namely Group ISB who received a combination of superficial cervical plexus block added to the Interscalene Nerve Block, and Group GA, for those who received GA. Duration of operation, waiting times, intraoperative hemodynamic data, postoperative visual analog scale (VAS), analgesic requirement, as well as patient and surgeon satisfaction levels, were compared between the 2 groups.

RESULTS

While VAS values at the post-anesthesia care unit were lower in ISB group at 2 and 24 hours (P < .05), there was no significant difference between VAS values measured at 6th and 12th hours (P ≥ .05). In the GA group, postoperative morphine and diclofenac consumption was higher, and rescue analgesia was needed earlier (P < .05). The hospital stay was shorter (P < .05), and surgeon and patient satisfaction were higher in the ISB group (P < .05).

CONCLUSION SUBSECTIONS

In rotator cuff tear repair anesthesia, ISB with superficial cervical plexus block provides adequate intraoperative anesthesia, low postoperative VAS level, reduced and deferred consumption of opioids and nonsteroidal anti-inflammatory drugs, higher patient and surgeon satisfaction and early discharge.

摘要

背景

在这项研究中,评估了在锁骨下臂丛神经阻滞(ISB)中加入颈浅丛阻滞并应用全身麻醉(GA)在接受肩袖撕裂修复的患者中的术中血流动力学、手术时间和术后镇痛需求。

方法

本前瞻性研究纳入了 70 名年龄在 18 至 75 岁之间的患者。所有患者均接受关节镜下肩袖撕裂修复手术。将患者随机分为 2 组,即接受颈浅丛阻滞联合 ISB 的 ISB 组和接受 GA 的 GA 组。比较 2 组患者的手术时间、等待时间、术中血流动力学数据、术后视觉模拟评分(VAS)、镇痛需求以及患者和术者满意度。

结果

ISB 组在麻醉后护理单元的 VAS 值在 2 小时和 24 小时时较低(P<0.05),但在 6 小时和 12 小时时的 VAS 值无显著差异(P≥0.05)。在 GA 组中,术后吗啡和双氯芬酸的消耗较高,且需要更早的解救性镇痛(P<0.05)。ISB 组的住院时间较短(P<0.05),术者和患者的满意度较高(P<0.05)。

结论

在肩袖撕裂修复麻醉中,ISB 联合颈浅丛阻滞可提供充分的术中麻醉、较低的术后 VAS 水平、减少和延迟阿片类药物和非甾体抗炎药的消耗、提高患者和术者的满意度并促进早期出院。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b73/10589582/8a57682bc304/medi-102-e35522-g001.jpg

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