Wang PengXia, Gu Jingjing, Wang Jianming, Liu ShanShan
Department of Anesthesia, Affiliated Chenggong Hospital of Xiamen University, 361003, Siming Street, Xiamen, Fujian, China.
Department of orthopaedics, Affiliated Chenggong Hospital of Xiamen University, 361003, Siming Street, Xiamen, Fujian, China.
BMC Anesthesiol. 2025 Aug 13;25(1):405. doi: 10.1186/s12871-025-03302-9.
Background: Shoulder arthroscopy is commonly performed to treat shoulder injuries, degenerative conditions, and chronic pain. The quality of postoperative emergence is critical to patient recovery and overall surgical outcomes. However, few studies have investigated whether controlled hypotension affects emergence quality during shoulder arthroscopy. Controlled hypotension can optimize the surgical field, reduce operative time, decrease the risk of intraoperative complications, and enhance the quality of postoperative recovery. These benefits highlight its clinical utility and support its broader adoption in routine practice.
A total of 120 patients (aged 18-60 years) scheduled for elective shoulder arthroscopy under general anaesthesia combined with brachial plexus nerve block were enrolled and randomly assigned to either the study group or the control group (n = 60 per group). In the study group, controlled hypotension was applied selectively during two key intraoperative phases: anchor stapling (T1) and suture knotting (T2). In contrast, the control group received continuous controlled hypotension throughout the entire procedure, targeting a 20% reduction in mean arterial pressure (MAP) from baseline upon entry into the operating room. Perioperative vital signs, quality of emergence from anaesthesia, and postoperative complications were recorded and analyzed.
The study group exhibited significantly shorter awakening and extubation times compared to the control group (both P < 0.001). Additionally, the incidences of postoperative nausea and vomiting (11.7% vs. 26.7%), shivering (20.0% vs. 45.0%), and agitation (5.0% vs. 16.7%) were significantly lower in the study group than in the control group (P = 0.037, P = 0.003, and P = 0.037, respectively). Multivariable analysis demonstrated that the study group had significantly shorter awakening time (P < 0.001) and extubation time (P < 0.001), as well as a significantly lower incidence of postoperative nausea and vomiting (P = 0.045), independent of confounding factors including temperature, drug dosage, and urine output.
Compared to patients who underwent continuous controlled hypotension throughout rotator cuff repair, those who received controlled hypotension only during critical surgical steps-specifically stapling (Fig. 1) and suture knotting (Fig. 2)-experienced higher-quality postoperative awakening and fewer complications.
randomized controlled trial, Chinese Clinicl Trial Registration, ChiCTR2400080822(Date08/02/2024).
肩关节镜检查常用于治疗肩部损伤、退行性疾病和慢性疼痛。术后苏醒质量对患者康复和整体手术效果至关重要。然而，很少有研究调查控制性低血压是否会影响肩关节镜检查期间的苏醒质量。控制性低血压可优化手术视野、缩短手术时间、降低术中并发症风险并提高术后恢复质量。这些益处凸显了其临床实用性，并支持其在常规实践中更广泛地应用。
总共120例计划在全身麻醉联合臂丛神经阻滞下进行择期肩关节镜检查的患者（年龄18 - 60岁）被纳入研究，并随机分为研究组或对照组（每组n = 60）。在研究组中，在两个关键的术中阶段选择性地应用控制性低血压：锚钉固定（T1）和缝合打结（T2）。相比之下，对照组在整个手术过程中持续进行控制性低血压，目标是进入手术室后平均动脉压（MAP）较基线降低20%。记录并分析围手术期生命体征、麻醉苏醒质量和术后并发症。
与对照组相比，研究组的苏醒和拔管时间明显更短（均P < 0.001）。此外，研究组术后恶心呕吐（11.7% 对26.7%）、寒战（20.0% 对45.0%）和躁动（5.0% 对16.7%）的发生率明显低于对照组（分别为P = 0.037、P = 0.003和P = 0.037）。多变量分析表明，研究组的苏醒时间（P < 0.001）和拔管时间（P < 0.001）明显更短，术后恶心呕吐的发生率也明显更低（P = 0.045），不受包括体温、药物剂量和尿量等混杂因素的影响。
与在整个肩袖修复过程中持续进行控制性低血压的患者相比，仅在关键手术步骤（具体为钉合（图1）和缝合打结（图2））期间接受控制性低血压的患者术后苏醒质量更高，并发症更少。
随机对照试验，中国临床试验注册中心，ChiCTR2400080822（日期：2024年02月08日）
