神经阻滞：术后镇痛

本文由“小麻哥的日常"授权转载

摘要译文

关节镜肩部手术中上干臂丛神经阻滞和肋锁间隙臂丛神经阻滞的随机比较：

一项非劣性研究

背景

上干臂丛神经阻滞（Superior trunk block，STB）提供非劣于肌间沟臂丛神经阻滞（interscalene block）的镇痛效果，并降低半膈肌麻痹（hemidiaphragmatic paralysis，HDP）的风险。

最近，研究证实肋锁间隙臂丛神经阻滞（costoclavicular block，CCB）时也可发生锁骨上扩散，是肩部手术的一种替代镇痛技术。

目的

本研究的目的是确定STB和CCB术后疼痛评分和HDP发生率是否存在差异。

设计

前瞻性随机对照试验。

机构

2021 1月至7月，位于大田的中南国立大学医院。

患者

招募了70名患者，年龄20至70岁，ASA身体状况分级为I至III级，计划进行选择性关节镜下肩袖修复。

干预措施

超声引导下用20ml 0.5%罗哌卡因进行STB或CCB。

主要测量指标

主要结局指标是术后1小时的疼痛评分（数字评分量表，NRS）。预先设定了1.4（NRS）的非劣性边缘。

HDP的发生率、术后肺功能的变化和术后阿片类药物的使用被纳入次要结局指标。

结果

术后1小时，CCB组的疼痛评分高于STB组（中位数差异为2；95%置信区间（CI）为1至3；未证明非劣性）。

CCB组中的两名患者因术后严重疼痛接受了补救性肌间沟臂丛神经阻滞。

CCB组完全性HDP的发生率较低（风险差异，−26%; 95%CI，−6至−45%; P<0.001）。

CCB组在1s内用力肺活量和用力呼气量的中值下降也显著较低。

结论

尽管HDP的发生率较低，但在关节镜下肩部手术中，CCB在术后即刻镇痛方面并没有显示出优于STB的效果。

原文摘要

Randomised comparison between superior trunk and costoclavicular blocks for arthroscopic shoulder surgery ：

A noninferiority study

BACKGROUND

Superior trunk block (STB) provides noninferior analgesia to the interscalene block and reduces the risk of hemidiaphragmatic paralysis (HDP). Recently, supraclavicular spreading has also been shown to occur during costoclavicular block (CCB), presenting as an alternative analgesic technique for shoulder surgery.

OBJECTIVE

The aim of this study was to determine whether there is a difference in postoperative pain scores and HDP incidence between STB and CCB.

DESIGN

Prospective randomised controlled trial.

SETTING

Chungnam National University Hospital in Daejeon from January to July 2021.

PATIENTS

Seventy patients, aged 20 to 70 years with ASA Physical Status classifications I to III and scheduled for elective arthroscopic rotator cuff repair were recruited.

INTERVENTION

Ultrasound-guided STB or CCB was performed with 20 ml 0.5% ropivacaine.

MAIN OUTCOME MEASURES

The   was the pain score (numeric rating scale, NRS) at 1 h postsurgery. A 1.4 (NRS) noninferiority margin was set a priori. The incidence of HDP, postoperative change of pulmonary function and postoperative opioid use were included as secondary outcomes.

RESULTS

The pain score was higher in the CCB group compared with the STB group at 1 h postoperatively (median difference, 2; 95% confidence interval (CI), 1 to 3; noninferiority was not demonstrated). Two patients in the CCB group received a rescue interscalene block due to severe postoperative pain. The incidence of complete HDP was lower in the CCB group (risk difference, −26%; 95% CI, −6 to −45%; P < 0.001). The median reduction in forced vital capacity and forced expiratory volume in 1 s were also significantly lower in the CCB group.

CONCLUSION

Although the incidence of HDP was lower, CCB did not show noninferiority in immediate postoperative analgesia compared with STB in arthroscopic shoulder surgery.

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编辑：Michel.米萱

校对：Mijohn.米江

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