关节镜肩关节手术后不同局部麻醉辅助药物联合应用于锁骨上臂丛神经阻滞的前瞻性随机对照试验。

Combination of different local anesthetic adjunct for supraclavicular brachial plexus block after arthroscopic shoulder surgery: a prospective randomized controlled trial.

机构信息

Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China.

出版信息

BMC Musculoskelet Disord. 2024 Oct 24;25(1):844. doi: 10.1186/s12891-024-07982-1.

DOI:10.1186/s12891-024-07982-1

PMID:39448947

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11515582/

Abstract

BACKGROUND

Acute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery.

METHODS

In this prospective randomized controlled trial, we allocated 80 patients into four groups: Group DMD (dexamethasone 10 mg + ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group DM (ropivacaine 100 mg + dexmedetomidine 50 µg + magnesium sulfate 250 mg), Group M (ropivacaine 100 mg + magnesium sulfate 250 mg) and Group D (ropivacaine 100 mg + dexmedetomidine 50 µg). The primary outcome was the time to first request for analgesia. Secondary outcome measures included cumulative opioid consumption at 6, 12, 18, 24, and 48 h postoperatively, VAS scores at 6, 12, 18, 24, and 48 h postoperatively and so on.

RESULTS

The time to first request for analgesia in Group DMD was significantly longer than Group DM (P = 0.011) and Group M (P = 0.003). The cumulative opioid consumption at 18 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.002) and Group M (P = 0.007). The cumulative opioid consumption at 24 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.016). The VAS score at 6 h postoperatively in Group DMD was significantly lower than in Group DM and Group M. The VAS score at 12 h postoperatively in Group DMD was significantly lower than in Group M. For American Shoulder and Elbow Surgeons Score, Group DMD had a better score than Group DM and Group D.

CONCLUSIONS

The analgesic efficacy of supraclavicular brachial plexus blockade combined with dexamethasone, magnesium sulfate, and dexmedetomidine is significantly superior to the combination of magnesium sulfate and dexmedetomidine, and significantly superior to the use of magnesium sulfate alone.

TRIAL REGISTRATION

This trial was registered in Chinese Clinical Trial Registry. (ChiCTR2200061181, Date of registration: June 15, 2022, http://www.chictr.org.cn ).

摘要

背景

关节镜肩关节手术后急性疼痛是一个主要问题，锁骨上臂丛阻滞已显示出良好的术后镇痛效果。然而，其镇痛持续时间不能满足临床需求。我们旨在探讨不同局部麻醉辅助药物的联合应用是否可以延长关节镜肩关节手术锁骨上臂丛阻滞的镇痛持续时间。

方法

在这项前瞻性随机对照试验中，我们将 80 名患者分为四组：DMD 组（地塞米松 10mg+罗哌卡因 100mg+右美托咪定 50μg+硫酸镁 250mg）、DM 组（罗哌卡因 100mg+右美托咪定 50μg+硫酸镁 250mg）、M 组（罗哌卡因 100mg+硫酸镁 250mg）和 D 组（罗哌卡因 100mg+右美托咪定 50μg）。主要结局是首次要求镇痛的时间。次要结局指标包括术后 6、12、18、24 和 48 小时的累积阿片类药物消耗、术后 6、12、18、24 和 48 小时的 VAS 评分等。

结果

DMD 组首次要求镇痛的时间明显长于 DM 组（P=0.011）和 M 组（P=0.003）。DMD 组术后 18 小时的累积阿片类药物消耗量明显低于 DM 组（P=0.002）和 M 组（P=0.007）。DMD 组术后 24 小时的累积阿片类药物消耗量明显低于 DM 组（P=0.016）。DMD 组术后 6 小时的 VAS 评分明显低于 DM 组和 M 组。DMD 组术后 12 小时的 VAS 评分明显低于 M 组。美国肩肘外科协会评分显示，DMD 组的评分优于 DM 组和 D 组。