Department of Anesthesiology, Perioperative, and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Department of Anesthesiology, Suqian Zhongwu Hospital, Suqian, Jiangsu, People's Republic of China.
Pain Physician. 2023 Nov;26(7):E843-E849.
The suprascapular nerve (SSN) is an important nerve that contributes to shoulder joint sensation and movement. The anterior suprascapular nerve block (aSSNB) has the potential for noninferior analgesic effect compared with the interscalene block while preserving respiratory function. This study investigated the median effective volume (MEV) of 0.375% ropivacaine in aSSNB for analgesic effect among patients undergoing arthroscopic shoulder surgery.
Our primary objective was the MEV. The secondary objectives included the 24 hour sufentanil consumption, 24 hour patient-controlled analgesia (PCA) presses, and incidences of diaphragm impairment.
Prospective registered (ChiCTR2300070129), single-armed, volume-finding study.
This study was conducted in a tertiary, single center.
There were 23 patients who completed the study. Using an up-and-down process, patients enrolled in the study received different volumes of 0.375% ropivacaine for an aSSNB adjusted based on the success or failure of the previous patient in the study's block by increasing or decreasing the volume by 3 mL. The first patient received 15 mL of 0.375% ropivacaine. The nerve blocks were evaluated by the sensory score of the C5 and C6 dermatomes.
MEV50 (50% of the patients) was 6 mL (95% CI, 5.78 - 6.78 mL), and MEV95 (95% of the patients) was 13.88 mL (95% CI, 13.37 - 14.87 mL). There was no significant difference in the PCA presses, 24 hour sufentanil consumption, and incidences of diaphragm impairments between successful and unsuccessful blocks.
Our study focused on the analgesic effect rather than hemi-diaphragmatic paralysis with 0.375% ropivacaine for an aSSNB. The study also did not test varying ropivacaine concentrations while keeping the volume constant. Further investigation with varying concentrations and a larger sample size is indicated to address the optimal volume and concentration to balance analgesia and diaphragm function.
To produce effective analgesic effect, the MEV50 is 6 mL, and the MEV95 is 13.88 mL in patients undergoing arthroscopic shoulder surgery who receive an aSSNB using 0.375% ropivacaine for analgesia.
肩胛上神经（SSN）是一条重要的神经，对肩关节的感觉和运动有贡献。与肌间沟阻滞相比，前路肩胛上神经阻滞（aSSNB）具有潜在的非劣效镇痛效果，同时保留呼吸功能。本研究旨在探讨 0.375%罗哌卡因在关节镜肩关节手术中进行 aSSNB 的中效容积（MEV），以评估其镇痛效果。
本研究的主要目的是确定 MEV。次要目标包括 24 小时舒芬太尼消耗量、24 小时患者自控镇痛（PCA）按压次数以及膈神经损伤发生率。
前瞻性注册（ChiCTR2300070129）、单臂、容积探索研究。
该研究在一家三级、单一中心进行。
共有 23 名患者完成了研究。采用上下法，根据前一位患者阻滞的成功或失败，调整接受不同容量（增加或减少 3 毫升）的 0.375%罗哌卡因前路肩胛上神经阻滞。第一例患者接受 15 毫升 0.375%罗哌卡因。通过 C5 和 C6 皮节的感觉评分评估神经阻滞。
MEV50（50%的患者）为 6 毫升（95%置信区间：5.78-6.78 毫升），MEV95（95%的患者）为 13.88 毫升（95%置信区间：13.37-14.87 毫升）。成功组和失败组之间的 PCA 按压次数、24 小时舒芬太尼消耗量和膈神经损伤发生率无显著差异。
本研究重点关注 0.375%罗哌卡因前路肩胛上神经阻滞的镇痛效果，而非半膈神经麻痹。此外，本研究并未测试在保持容量不变的情况下不同罗哌卡因浓度的效果。需要进一步进行不同浓度和更大样本量的研究，以确定平衡镇痛和膈神经功能的最佳容量和浓度。
对于接受关节镜肩关节手术的患者，使用 0.375%罗哌卡因进行前路肩胛上神经阻滞以达到镇痛效果时，MEV50 为 6 毫升，MEV95 为 13.88 毫升。
