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肩部手术中连续导管与单次肌间沟阻滞的比较:术后疼痛管理的综述与建议

Continuous Catheter Versus Single-Shot Interscalene Block in Shoulder Surgery: A Review and Recommendations for Postoperative Pain Management.

作者信息

Karadimas Thomas L, Nuss Kalie L, Bridgeport Ryan D, James Morgan, Hapipis Panteli, Buchanan Austin, Champane James

机构信息

Medicine, Morsani College of Medicine, USF Health, Tampa, USA.

Natural Science, College of Natural Science, Michigan State University, East Lansing, USA.

出版信息

Cureus. 2024 Dec 8;16(12):e75332. doi: 10.7759/cureus.75332. eCollection 2024 Dec.

Abstract

Shoulder arthroscopic and arthroplastic surgeries are associated with significant postoperative pain, which can delay recovery and increase opioid consumption. Interscalene blocks (ISBs) are a commonly used method to manage this pain, either as single-shot injections or continuous catheter infusions (CISBs). This review synthesizes findings from studies conducted in the past five years, comparing the efficacy, complications, and outcomes of single-shot ISBs versus CISBs for postoperative pain management in shoulder surgeries. Current literature highlights key differences: single-shot ISBs provide significant immediate postoperative pain relief, whereas CISBs offer prolonged analgesia beyond 48 hours, reduced opioid consumption, and enhanced recovery outcomes. However, CISBs carry a higher risk of complications and procedural complexity compared to single-shot ISBs. Both single-shot ISBs and CISBs present effective options for postoperative pain control in shoulder surgery patients. Single-shot ISBs may be preferable for patients seeking immediate pain relief with fewer complications, while CISBs are beneficial for those requiring prolonged analgesia. The choice of technique should be individualized based on the patient's needs, expected recovery, and potential risk factors.

摘要

肩关节镜手术和关节成形术会导致严重的术后疼痛,这可能会延迟恢复并增加阿片类药物的使用量。肌间沟阻滞(ISB)是一种常用的疼痛管理方法,可单次注射或连续导管输注(CISB)。本综述综合了过去五年的研究结果,比较了单次ISB与CISB在肩关节手术术后疼痛管理中的疗效、并发症和结果。当前文献突出了关键差异:单次ISB可在术后立即显著缓解疼痛,而CISB可提供超过48小时的延长镇痛效果,减少阿片类药物的使用量,并改善恢复结果。然而,与单次ISB相比,CISB的并发症风险更高,操作更复杂。单次ISB和CISB都是肩关节手术患者术后疼痛控制的有效选择。对于寻求立即缓解疼痛且并发症较少的患者,单次ISB可能更合适,而CISB则对那些需要延长镇痛的患者有益。应根据患者的需求、预期恢复情况和潜在风险因素进行个体化技术选择。

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