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| 超声引导下前路肩胛上神经阻滞对肩关节镜手术患者术后恢复质量的影响 |
| Effect of ultrasound-guided anterior suprascapular nerve block on postoperative recovery quality in patients undergoing shoulder arthroscopic surgery |
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| DOI：10.12089/jca.2022.01.002 |
| 中文关键词: 肩胛上神经阻滞 肌间沟臂丛神经阻滞 膈肌麻痹 慢性疼痛 焦虑 抑郁 |
| 英文关键词: Suprascapular nerve block Interscalene brachial plexus block Diaphragmatic paralysis Chronic pain Anxiety Depression |
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| 中文摘要: |
目的 评估超声引导下前路肩胛上神经阻滞（SSNB）对肩关节镜手术患者术后恢复质量的影响。
方法 选择择期行单侧肩关节镜肩袖修补术患者60例，男25例，女35例，年龄18～64岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字法将患者随机分为两组：前路SSNB组（S组）和肌间沟臂丛神经阻滞（ISBPB）组（I组），每组30例。全麻诱导前，S组行超声引导下前路SSNB，I组行超声引导下ISBPB，均给予0.375%罗哌卡因15 ml。术毕两组均行患者自控静脉镇痛（PCIA）。记录拔管后30 min和术后3、6、12、24 h静息时VAS疼痛评分以及术后12、24 h活动时VAS疼痛评分。于阻滞前、阻滞后30 min及拔管后3 h，采用超声评估膈肌麻痹的情况；采用肺功能检查仪测量第一秒用力呼气容积（FEV1）和用力肺活量（FVC）。记录术后24 h内镇痛泵有效按压次数及哌替啶补救镇痛例数。随访术后3个月慢性疼痛和焦虑/抑郁的发生情况。
结果 拔管后30 min S组静息时VAS疼痛评分明显高于I组（P<0.05）。阻滞后30 min S组膈肌麻痹率明显低于I组（P<0.05）。与阻滞后30 min比较，拔管后3 h I组膈肌麻痹率明显降低（P<0.05）。与阻滞前比较，阻滞后30 min I组FEV1、FVC明显降低（P<0.05）。阻滞后30 min S组FEV1、FVC明显高于I组（P<0.05）。术后24 h内两组镇痛泵有效按压次数及补救镇痛率差异无统计学意义。术后3个月两组慢性疼痛和焦虑/抑郁发生率差异无统计学意义。
结论 与肌间沟臂丛神经阻滞比较，超声引导下前路肩胛上神经阻滞对肺功能影响更小，可提供良好的术后镇痛效果，且未增加患者术后3个月慢性疼痛和焦虑/抑郁的发生。 |
| 英文摘要: |
Objective To evaluate the effect of ultrasound-guided anterior suprascapular nerve block (SSNB) on postoperative recovery quality in patients undergoing shoulder arthroscopic surgery.
Methods Sixty patients who received unilateral arthroscopic repair of rotator cuff, 25 males and 35 females, aged 18-64 years, BMI 18-25 kg/m2, ASA physical status Ⅰ or Ⅱ, were involved in the study. All the patients were randomized into two groups: SSNB group (group S) and interscalene brachial plexus block (ISBPB) group (group I), 30 patients in each group. Before the induction of general anesthesia, the patients in group S were performed ultrasound-guided anterior SSNB, and the patients in group I were treated with ultrasound-guided ISBPB, all administrated with 0.375% ropivacaine 15 ml. All the patients underwent patient-controlled intravenous analgesia (PCIA) after surgery. Visual analog scale (VAS) at rest were examined 30 minutes after extubation, 3, 6, 12, 24 hours postoperatively, and VAS on upper-limb movement were examined at 12 and 24 hours postoperatively. The diaphragmatic paralysis was evaluated before the block, 30 minutes after the block, and 3 hours after extubation, and forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were recorded at corresponding time points. The number of effective pressing times of PCIA pump and the number of patients who received remedial analgesia within 24 hours after operation were recorded. The incidence of chronic pain was calculated 3 months after operation. Anxiety/depression were measured at 3 months postoperatively.
Results Compared with group I, VAS score at rest 30 minutes after extubation was higher in group S (P < 0.05). Compared with group I, the diaphragmatic paralysis rate in group S was lower 30 minutes after block (P < 0.05). Compared with 30 minutes after block, the diaphragmatic paralysis rate was lower 3 hours after extubation in group I (P < 0.05). Compared with before block, FEV1 and FVC in group I were significantly decreased 30 minutes after block (P < 0.05). FEV1 and FVC in group S were significantly increased 30 minutes after block than those in group I (P < 0.05). There was no significant difference in the effective pressing times and remedial analgesia rate between the two groups within 24 hours postoperatively. There was no significant difference in the incidence of chronic pain and anxiety/depression 3 months after operation.
Conclusion Compared with ISBPB, ultrasound-guided anterior SSNB provides analgesia with less impact on postoperative lung function and dose not increase the incidence of chronic pain or anxiety/depression 3 months after surgery. |
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