Muittari P, Kirvelä O
Department of Anesthesiology, Turku University Hospital, Finland.
Reg Anesth Pain Med. 1998 Sep-Oct;23(5):474-8. doi: 10.1016/s1098-7339(98)90030-x.
Peripherally administered opioids, e.g., intra-articular morphine, exert their analgesic action on local opioid receptors. The present study investigated the safety and efficacy of intrabursal oxycodone and bupivacaine in comparison with bupivacaine infiltration and interscalene brachial plexus block in conjunction with shoulder surgery.
A prospective, randomized study was conducted in 45 patients (15 per group) undergoing elective shoulder surgery during general anesthesia. At the end of the surgery, patients received either 10 mL 0.5% bupivacaine (group B) or 5 mg oxycodone and 10 mL 0.5% bupivacaine (group OB) in the subacromial bursa; interscalene plexus blocks were performed preoperative (group IPB). Postoperative analgesia was provided by patient-controlled analgesia, and the amount of intravenous fentanyl used during the total perioperative period was recorded. Postoperative pain was assessed by a visual analog scale.
The total fentanyl consumption was lower in groups OB and IPB than in group B, and the difference reached statistical significance for both groups (P = .045 and P = .006, respectively). However, the groups OB and IPB did not differ in respect to their fentanyl requirements (P = 1.000). Visual analog scores for pain were lowest in group IBP during the first 6 postoperative hours. The incidence of adverse effects was similar in all groups; serious adverse effects did not occur.
According to the present study, intrabursal oxycodone and bupivacaine offer an acceptable and efficient method for postoperative analgesia after shoulder surgery.
外周给予的阿片类药物，如关节腔内注射吗啡，通过作用于局部阿片受体发挥镇痛作用。本研究比较了滑囊内注射羟考酮和布比卡因与布比卡因浸润及肌间沟臂丛神经阻滞用于肩部手术的安全性和有效性。
对45例在全身麻醉下接受择期肩部手术的患者（每组15例）进行了一项前瞻性随机研究。手术结束时，患者在肩峰下囊内接受10 mL 0.5%布比卡因（B组）或5 mg羟考酮加10 mL 0.5%布比卡因（OB组）；术前进行肌间沟神经阻滞（IPB组）。通过患者自控镇痛提供术后镇痛，并记录围手术期静脉注射芬太尼的用量。采用视觉模拟评分法评估术后疼痛。
OB组和IPB组的芬太尼总用量低于B组，两组差异均有统计学意义（分别为P = 0.045和P = 0.006）。然而，OB组和IPB组在芬太尼需求量方面无差异（P = 1.000）。术后最初6小时内，IPB组的疼痛视觉模拟评分最低。所有组的不良反应发生率相似；未发生严重不良反应。
根据本研究，滑囊内注射羟考酮和布比卡因是肩部手术后一种可接受且有效的术后镇痛方法。
