Zhou Guoxia, Yang Yuecheng, Zhang Yunkui, Pan Congxia, Wu Xing, Zhang Jun
Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.
Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.
J Pain Res. 2024 Sep 30;17:3177-3185. doi: 10.2147/JPR.S478735. eCollection 2024.
To investigate the efficacy of ultrasound-guided interscalene brachial plexus block in the treatment of shoulder pain following hepatectomy.
A randomized controlled trial.
We conducted a single-center, randomized controlled trial. Forty-four patients with shoulder pain scores of at least 5 were randomly assigned to two groups: the treatment group, which received 0.5% ropivacaine (5mL) combined with dexamethasone (5 mg) (n=22), and the control group, which received normal saline (5mL) (n=22). The intervention was performed in the postanesthesia care unit after shoulder pain was identified by using the visual analogue scale. The shoulder pain was re-evaluated 15 minutes after intervention. The incidence of effective pain relief, defined as at least 75% reduction in pain intensity, was the primary outcome. Secondary outcomes included shoulder pain intensity within 2 days after surgery, the timing of the first rescue analgesia, total additional analgesic use, arterial oxygen saturation, intervention-related adverse reactions, and patient satisfaction regarding shoulder pain.
The incidence of effective pain relief was significantly higher in the treatment group compared to the control group (15 (68.2%) vs 2 (9.1%), <0.001). The interscalene brachial plexus block not only prolonged the time to first analgesic request ( <0.001), but also reduced the number of analgesic requests ( <0.001). In the comparison between groups, arterial oxygen saturation was lower in the control group than that in the treatment group, attributed to the use of sufentanil for remedial analgesia (92.4% vs 94.5%, =0.014).
Interscalene brachial plexus block can effectively relieve post-hepatectomy shoulder pain without clinically significant hypoxemia.
探讨超声引导下肌间沟臂丛神经阻滞治疗肝切除术后肩部疼痛的疗效。
一项随机对照试验。
我们进行了一项单中心随机对照试验。44例肩部疼痛评分至少为5分的患者被随机分为两组：治疗组，接受0.5%罗哌卡因（5mL）联合地塞米松（5mg）（n = 22）；对照组，接受生理盐水（5mL）（n = 22）。在麻醉后护理单元，使用视觉模拟量表确定肩部疼痛后进行干预。干预后15分钟重新评估肩部疼痛。主要结局是有效缓解疼痛的发生率，定义为疼痛强度至少降低75%。次要结局包括术后2天内的肩部疼痛强度、首次补救镇痛的时间、额外镇痛药物的总用量、动脉血氧饱和度、与干预相关的不良反应以及患者对肩部疼痛的满意度。
治疗组有效缓解疼痛的发生率显著高于对照组（15例（68.2%）对2例（9.1%），P<0.001）。肌间沟臂丛神经阻滞不仅延长了首次镇痛需求的时间（P<0.001），还减少了镇痛需求的次数（P<0.001）。在组间比较中，对照组的动脉血氧饱和度低于治疗组，这归因于使用舒芬太尼进行补救镇痛（92.4%对94.5%，P = 0.014）。
肌间沟臂丛神经阻滞可有效缓解肝切除术后肩部疼痛，且无临床显著的低氧血症。
