超声引导下冈下肌小圆肌筋膜间阻滞和肌间沟臂丛神经阻滞在肩关节镜术后镇痛效果的比较  

Comparison of the analgesic effects of infraspinatus-teres minor interfascial block and interscalene block under ultrasound guidance in patients undergoing arthroscopic shoulder surgery

作　　者：谢磊[1,2] 贾晓玉 安明梓 席亚枝 李振平 周清河 Xie Lei;Jia Xiaoyu;An Mingzi;Xi Yazhi;Li Zhenping;Zhou Qinghe(Department of Anesthesiology,Zhejiang Chinese Medical University,Hangzhou 330100,China;Department of Anesthesiology,Jiaxing University Affiliated Hospital,Jiaxing 314000,China)

机构地区：[1]浙江中医药大学麻醉学系,杭州330100 [2]嘉兴大学附属医院麻醉科,嘉兴314000

出　　处：《中华医学杂志》2024年第39期3661-3668,共8页National Medical Journal of China

基　　金：嘉兴市医学重点学科-麻醉学(2023-ZC-001);浙江省中医药重点创新团队项目(2022-19)。

摘　　要：目的评价超声引导下冈下肌小圆肌筋膜间阻滞与肌间沟臂丛神经阻滞在肩关节镜术后的镇痛效果。方法前瞻性纳入2023年12月至2024年2月嘉兴大学附属医院行肩关节镜手术患者74例,年龄18~80岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级。根据不同区域神经阻滞方法,采用区组随机化分组将患者分为冈下肌小圆肌筋膜间阻滞组(观察组)和肌间沟臂丛神经阻滞组(对照组),每组37例。两组患者均在麻醉准备室行超声引导下神经阻滞,阻滞药物均为0.375%罗哌卡因20 ml。术后均行静脉自控镇痛(PCIA)。主要结局指标为术后24 h内数字疼痛评分量表(NRS)的曲线下面积(AUC)。次要结局指标包括术后48 h内最高NRS评分、术后48 h内PCIA舒芬太尼用量、补救镇痛发生率、反跳痛发生率、恢复质量量表(QoR-40)评分以及术后24 h内恶心呕吐发生率等。设定两种区域神经阻滞术后NRS评分的AUC非劣效性界值为"2.6"。结果最终观察组纳入35例[男17例,女18例,年龄(58.1±9.1)岁],对照组纳入36例[男12例,女24例,年龄(57.0±9.8)岁]。观察组术后24 h内静息时NRS评分的AUC为51.7±10.9,对照组术后24 h内静息时NRS评分的AUC为62.6±13.6,两组AUC差值为-10.9(95%CI:-16.8~-5.1),95%CI上限低于预设定的非劣效性界值"2.6"(非劣效性P<0.001)。对照组术后48 h内最高NRS评分[M(Q1,Q3)]为3(3,4)分,高于观察组的2(2,3)分(P<0.001)。术后0~12 h,观察组舒芬太尼用量为12(10,14)μg,多于对照组的8(6,10)μg(P<0.001);术后12~24 h,观察组舒芬太尼用量为8(8,10)μg,少于对照组的12(10,14)μg(P<0.001);术后24~48 h,两组患者舒芬太尼用量差异无统计学意义(P=0.548)。观察组术后48 h内补救镇痛发生率为0(0/35),低于对照组的22.2%(8/36)(P=0.010)。观察组反跳痛发生率为0(0/35),对照组为11.1%(4/36),差异无统计学意义(P=0.130)。观察组术后24 h内QoR-40评分为(180.2±3.2)分,高于对照组的(175.8±4.7)分(P<0.001)。�Objective To compare the postoperative analgesic efficacy of ultrasound-guided infraspinatus-teres minor interfascial block and interscalene block in shoulder arthroscopic surgery.Methods A total of 74 patients undergoing shoulder arthroscopic surgery at the Affiliated Hospital of Jiaxing University from December 2023 to February 2024 were prospectively included,whose age ranged from 18 to 80 years and the American Society of Anesthesiologists(ASA)grade wereⅠ-Ⅲ.Patients were divided into two groups using block randomization:infraspinatus-teres minor interfascial block group(observation group)and interscalene block group(control group),with 37 cases in each group.In the anesthesia preparation room,all patients received nerve blocks under ultrasound guidance with 20 ml of 0.375%ropivacaine.Patient-controlled intravenous analgesia(PCIA)was administered to all patients following surgery.The primary outcome was the area under the curve(AUC)of the numeric rating scale(NRS)for pain within 24 hours postoperatively.Secondary outcome measures included the highest NRS score within 48 hours postoperatively,the amount of sufentanil used via PCIA within 48 hours postoperatively,the incidence of rescue analgesia and rebound pain,QoR-40 scores,and the rate of postoperative nausea and vomiting within 24 hours.The non-inferiority margin for the AUC of NRS scores between the two types of regional nerve blocks was set at"2.6".Results A total of 35 patients were included in the observation group[17 males,18 females,aged(58.1±9.1)years],and 36 patients were included in the control group[12 males,24 females,aged(57.0±9.8)years].The AUC of the NRS scores at rest within 24 hours post-operation was 51.7±10.9 in the observation group and 62.6±13.6 in the control group.The difference in AUC between the two groups was-10.9(95%CI:-16.8--5.1),with the upper limit of the 95%CI falling below the predefined non-inferiority margin of"2.6"(non-inferiority P<0.001).The highest NRS score[M(Q 1,Q 3)]within 48 hours post-surgery was 3(3,4)in th

关 键 词：镇痛 冈下肌小圆肌筋膜间阻滞 肌间沟臂丛神经阻滞 超声引导 肩关节镜手术 

分 类 号：R61[医药卫生—外科学]