肩关节镜引导下肩胛上神经阻滞在肩袖损伤术后镇痛中的疗效分析

Efficacy of direct arthroscopy-guided suprascapular nerve block under shoulder arthroscopy in postoperative analgesia of rotator cuff repair

摘要:

比较关节镜引导下肩胛上神经阻滞与超声引导下肌间沟臂丛神经阻滞联合全麻在肩关节镜下肩袖修补术后48 h的镇痛效果。方法 选择该院2018年4月－2018年6月侧卧位下行肩关节镜择期手术的患者50例，按随机数字表法随机分为A、B两组，各25例，均行气管插管全身麻醉，A组在全身麻醉后肩关节镜引导下用0.2%罗哌卡因20 ml行肩胛上神经阻滞，B组全身麻醉后在超声引导下用0.2%罗哌卡因20 ml行肌间沟神经阻滞。比较两组患者术后2、4、8、12、24和48 h静息状态下视觉模拟评分（VAS）、术后48 h内非甾体类止痛药用量、术后不良反应和术后48 h镇痛满意度。结果 A组和B组患者术后2、4、8、12、24和48 h的VAS评分分别为1（0.0，1.0）和1（0.0，2.0）分、1（1.0，1.5）和1（1.0，2.0）分、（2.52±1.48）和（3.80±2.60）分、（3.32±1.55）和（4.68±2.30）分、（2.60±1.35）和（3.56±1.39）分、（2.28±0.94）和（2.92±1.96）分；两组术后2、4和48 h的VAS评分差异无统计学意义（P >0.05），术后8、12和24 h两组VAS评分，差异有统计学意义（P <0.05）；两组患者术后镇痛药氟比洛芬酯使用量分别为（62.00±38.94）和（92.00±49.33）mg，差异有统计学意义（P <0.05）；A组哌替啶使用率比B组少，差异有统计学意义（P <0.05）；术后48 h内A组患肢麻木感发生率为0.00%（0/25），B组术后均有麻木感，48 h内麻木感逐渐消失；两组术后48 h镇痛满意度评分比较，差异有统计学意义（P <0.05）。结论 关节镜引导下肩胛上神经阻滞与常规超声引导下肌间沟臂丛神经阻滞比较，前者应用于肩关节镜术后8、12和24 h镇痛效果较好，副作用小，有利于早期康复，更易被患者接受。

Abstract:

To compare the results of arthroscopy-guided suprascapular nerve block (SSNB) with those of ultrasound- guided interscalene brachial plexus block (ISB) in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. Methods 50 patients underwent arthroscopic shoulder surgery were randomly allocated to either of the following two groups: group A (n = 25) arthroscopy-guided SSNB was performed by injection of 20 ml of 0.2% Ropivacaine followed general anesthesia; group B (n = 25): ultrasound- guided ISB was performed by preoperative injection of 20 ml of 0.2% Ropivacaine followed general anesthesia. Visual analogue scale (VAS) pain score and adverse effect were recorded at 2 h, 4 h, 8 h, 12 h, 24 h and 48 h post-operation. The amount of non-steroidal analgesic in 48 h after operation and patient satisfaction score were evaluated. Results VAS score between the A group and B group at 2 h, 4 h, 8 h, 12 h, 24 h and 48 h after surgery were 1(0.0, 1.0), 1(0.0, 2.0); 1(1.0, 1.5), 1(1.0, 2.0); (2.52 ± 1.48), (3.80 ± 2.60); (3.32 ± 1.55), (4.68 ± 2.30); (2.60 ± 1.35), (3.56 ± 1.39); (2.28 ± 0.94), (2.92 ± 1.96). There was no statistically difference in VAS at 2 h, 4 h, 12 h, 24 h and 48 h post-operation between group A and group B (P > 0.05). While group A had lower VAS at 8 h, 12 h and 24 h postoperatively compared with the group B (P < 0.05). Patients in group A had a higher patient satisfaction (P < 0.05), and had no numbness of affected limb (0.00% vs 100.00%, P < 0.05). Conclusion Compared with conventional ultrasound- guided ISB, arthroscopy-guided SSNB has a better analgesic effect at the 8h, 12h and 24 h after shoulder arthroscopy, with fewer side effects, which is conducive to early rehabilitation training and easier to be accepted by patients.