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不同局麻药联合治疗肩关节镜手术后锁骨上臂丛神经阻滞：一项前瞻性随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：田明德 编辑：田明德 审校：曹莹
背景：急性疼痛是肩关节镜手术后的主要问题，锁骨上臂丛阻滞已显示出良好的术后镇痛效果。但其镇痛持续时间不能满足临床需要。我们的目的是探讨不同局麻药联合使用是否可以延长关节镜肩关节手术锁骨上臂丛阻滞的镇痛时间。
方法：在这项前瞻性随机对照试验中，我们将80例患者分为4组：DMD组（地塞米松10 mg +罗哌卡因100 mg +右美托咪定50µg +硫酸镁250 mg）、DM组（罗哌卡因100 mg +右美托咪定50µg +硫酸镁250 mg）、M组（罗哌卡因100 mg +硫酸镁250 mg）和D组（罗哌卡因100 mg +右美托咪定50µg）。主要观察指标为首次要求镇痛的时间。次要结局指标包括术后6、12、18、24和48 h的阿片类药物累积消耗，术后6、12、18、24和48 h的VAS评分等。
结果：DMD组首次请求镇痛时间明显长于DM组（P = 0.011）和M组（P = 0.003）。术后18 h， DMD组阿片类药物累积消耗量显著低于DM组（P = 0.002）和M组（P = 0.007）。术后24 h， DMD组阿片类药物累计消耗量显著低于DM组（P = 0.016）。DMD组术后6 h VAS评分明显低于DM组和m组。DMD组术后12 h VAS评分明显低于m组。美国肩肘外科医生评分DMD组优于DM组和D组。
结论：锁骨上臂丛阻滞联合地塞米松、硫酸镁、右美托咪定的镇痛效果明显优于硫酸镁与右美托咪定的联用，也明显优于硫酸镁的单用。
原始文献来源：Wu J, Chen G, Quan X, et al. Combination of different local anesthetic adjunct for supraclavicular brachial plexus block after arthroscopic shoulder surgery: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2024;25(1):844. Published 2024 Oct 24.
Combination of different local anesthetic adjunct for supraclavicular brachial plexus block after arthroscopic shoulder surgery: a prospective randomized controlled trial
Abstract
Background:Acute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery.
Method: Acute pain is a major concern after arthroscopic shoulder surgery, supraclavicular brachial plexus blockade has shown favorable postoperative analgesic effects. However, its duration of analgesia does not meet clinical needs. We aimed to explore whether the combination of different local anesthetic adjunct can prolong the analgesic duration of supraclavicular brachial plexus block for arthroscopic shoulder surgery.
Results:The time to first request for analgesia in Group DMD was significantly longer than Group DM (P = 0.011) and Group M (P = 0.003). The cumulative opioid consumption at 18 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.002) and Group M (P = 0.007). The cumulative opioid consumption at 24 h postoperatively in Group DMD was significantly lower than in Group DM (P = 0.016). The VAS score at 6 h postoperatively in Group DMD was significantly lower than in Group DM and Group M. The VAS score at 12 h postoperatively in Group DMD was significantly lower than in Group M. For American Shoulder and Elbow Surgeons Score, Group DMD had a better score than Group DM and Group D.
Conclusion:The analgesic efficacy of supraclavicular brachial plexus blockade combined with dexamethasone, magnesium sulfate, and dexmedetomidine is significantly superior to the combination of magnesium sulfate and dexmedetomidine, and significantly superior to the use of magnesium sulfate alone.
