Department of Anaesthesiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; Department of Anaesthesia, Pain & Perioperative Medicine, Queen Mary Hospital, Hong Kong, China.
Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
Anesthesiology. 2024 Oct 1;141(4):732-744. doi: 10.1097/ALN.0000000000005035.
The analgesic effect of adding liposomal bupivacaine to standard bupivacaine in supraclavicular brachial plexus block is not known. The authors hypothesized that addition of liposomal bupivacaine would reduce acute postoperative pain compared to standard bupivacaine alone.
A randomized controlled trial was conducted. Patients and outcome assessors were blinded. Eighty patients undergoing distal radial fracture fixation during regional anesthesia with supraclavicular brachial plexus block were randomized into two groups. The liposomal bupivacaine group received 10 ml 0.5% plain bupivacaine immediately followed by 10 ml 1.33% liposomal bupivacaine (n = 40). The standard bupivacaine group received 20 ml 0.5% plain bupivacaine (n = 40). The primary outcome was weighted area under curve (AUC) numerical rating scale pain score at rest during the first 48 h after surgery. Secondary outcomes included weighted AUC scores for pain with movement, overall benefit with analgesia score, and other functional scores.
For the primary outcome, the liposomal bupivacaine group was associated with statistically significantly lower weighted AUC pain score at rest (0.6 vs. 1.4; P < 0.001) in the first 48 h. Of the secondary outcomes, no difference between treatment groups reached statistical significance with the exception of weighted AUC score for pain with movement (2.3 vs. 3.7; adjusted P < 0.001) and overall benefit with analgesia score (1.1 vs. 1.7; adjusted P = 0.020) in the first 48 h, as well as numerical rating scale pain score at rest (0.5 vs. 1.9; adjusted P < 0.001) and with movement (2.7 vs. 4.9; adjusted P < 0.001) on postoperative day 1. Differences in numerical rating scale pain scores on postoperative days 2, 3, and 4 did not reach the level of statistical significance. There were no statistically significant differences in sensory function.
Liposomal bupivacaine given via supraclavicular brachial plexus block reduced pain at rest in the early postoperative period.
在锁骨上臂丛神经阻滞中加入脂质体布比卡因是否比单独使用标准布比卡因具有更好的镇痛效果尚不清楚。作者假设与单独使用标准布比卡因相比，加入脂质体布比卡因可减少急性术后疼痛。
进行了一项随机对照试验。患者和结果评估者均为盲法。80 例行桡骨远端骨折切开复位内固定术的患者，在接受锁骨上臂丛神经阻滞时随机分为两组。脂质体布比卡因组在注射 10ml 0.5%布比卡因后立即给予 10ml 1.33%脂质体布比卡因（n=40）。标准布比卡因组给予 20ml 0.5%布比卡因（n=40）。主要结局是术后 48 小时内静息时数字评定量表（NRS）疼痛评分的加权曲线下面积（AUC）。次要结局包括运动时疼痛的加权 AUC 评分、整体镇痛效果评分和其他功能评分。
在主要结局方面，在术后 48 小时内，脂质体布比卡因组静息时的加权 AUC 疼痛评分显著低于标准布比卡因组（0.6 比 1.4；P<0.001）。在次要结局方面，除运动时疼痛的加权 AUC 评分（2.3 比 3.7；调整后 P<0.001）和整体镇痛效果评分（1.1 比 1.7；调整后 P=0.020）外，两组之间的差异均无统计学意义，而在术后第 1 天，静息时和运动时的 NRS 疼痛评分（0.5 比 1.9；调整后 P<0.001）和（2.7 比 4.9；调整后 P<0.001）以及术后第 2、3、4 天的 NRS 疼痛评分差异均无统计学意义。两组感觉功能无统计学差异。
锁骨上臂丛神经阻滞中给予脂质体布比卡因可减少术后早期静息时的疼痛。
