Pain and Intensive Care Medicine, Fayoum University, Fayoum, Egypt.
Pain Physician. 2023 Nov;26(7):E787-E796.
The gold standard postoperative analgesia protocol for arthroscopic rotator cuff repair procedures is the interscalene block (ISB), which prevents the significant consequences of phrenic nerve block associated with hemidiaphragmatic paralysis (HDP). The infraclavicular brachial plexus block (BPB) combined with the suprascapular nerve block (SSNB) had the same analgesic efficacy as the infraclavicular BPB alone, with no effect on respiration.
Therefore, the study aimed to assess the HDP and analgesic efficacy of both approaches in controlling pain following arthroscopic rotator cuff repair surgeries.
A prospective, randomized, double-blind, and comparative clinical trial.
The study comprised 66 patients. They were separated into 2 equal parallel groups 33 patients each: the ISB group and the costoclavicular and suprascapular block (CSB) group.
The ISB group obtained the ISB followed by the general anesthesia. The CSB group received infraclavicular blockade using the costoclavicular approach and SSNB followed by general anesthesia.
Considering morphine utilization during the first day following the operation, the groups demonstrated an insignificant difference. The CSB group showed a decreased rate of diaphragmatic paralysis.
There was no control group. And, the blocks might take a long time to be performed up to 30 minutes. Also, there were no validated criteria to define HDP based on M-mode ultrasound measurements.
The employment of the costoclavicular block in combination with the suprascapular block may provide a comparable analgesic potency to the sole use of the standard ISB with no HDP.
关节镜肩袖修复术后的金标准术后镇痛方案是肌间沟阻滞（ISB），它可以防止膈神经阻滞引起的显著后果，即膈肌麻痹（HDP）。锁骨下臂丛神经阻滞（BPB）联合肩胛上神经阻滞（SSNB）与单独使用锁骨下 BPB 具有相同的镇痛效果，对呼吸无影响。
因此，本研究旨在评估这两种方法在控制关节镜肩袖修复手术后疼痛方面的 HDP 和镇痛效果。
前瞻性、随机、双盲、对照临床试验。
研究纳入 66 例患者。他们被分为 2 个相等的平行组，每组 33 例：ISB 组和锁骨下和肩胛上阻滞（CSB）组。
ISB 组在全身麻醉前先进行 ISB，CSB 组在全身麻醉前先进行锁骨下阻滞（锁骨下阻滞）和 SSNB。
考虑到术后第一天吗啡的使用量，两组无显著差异。CSB 组膈神经麻痹发生率降低。
没有对照组。而且，阻滞可能需要很长时间（长达 30 分钟）才能完成。此外，没有基于 M 模式超声测量的 HDP 的验证标准。
锁骨下阻滞联合肩胛上阻滞的应用可能提供与单独使用标准 ISB 相似的镇痛效果，且无 HDP。
