Comparison of anterior suprascapular nerve block versus interscalane nerve block in terms of diaphragm paralysis in arthroscopic shoulder surgery: a prospective randomized clinical study.
Alper Tunga Doğan, Sami Kaan Coşarcan, Yavuz Gürkan, Özgür Koyuncu, Ömür Erçelen, Mehmet Demirhan
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引用次数: 1
Abstract
Objective: This prospective, randomized study aimed to compare anterior suprascapular nerve block versus interscalene block in terms of diaphragm paralysis in arthroscopic shoulder surgery.
Methods: Fifty-two patients undergoing shoulder arthroscopy surgery were prospectively randomly assigned to interscalene block (n=25) or anterior suprascapular nerve block groups (n=27) (each group receiving 5 mL, 0.5% bupivacaine). The ipsilateral diaphrag matic excursion was assessed in all patients using ultrasound imaging before (baseline), 30 minutes, and 24 hours after block completion. Pain scores were recorded 1 hour preoperative, 30-60 minutes in the postoperative recovery unit, and at 6 and 24 hours postoperatively.
Results: No complete paralysis was observed in either treatment group. The incidence of a partial decrease in diaphragm movements was significantly lower in the anterior suprascapular nerve block than in the interscalene block group (1 vs. 21 patients) (P < .01). Twenty-six patients in the anterior suprascapular nerve block and 4 in the interscalene block group had less than a 25% decrease in hemidiaphrag matic movements, 30 minutes after the blockade. Pain scores were similar in the 2 groups. However, mean pain scores at 24 hours post operatively were significantly higher in the interscalene block than in the anterior suprascapular nerve block group (P < .05). Time to first pain post-block was significantly longer in the anterior suprascapular nerve block compared to the interscalene block group (677.04 ± 52.17 minutes vs. 479.2 ± 99.74 minutes, P < .05).
Conclusion: Anterior suprascapular nerve block and interscalene block both appear to be clinically effective in providing postoperative analgesia for patients undergoing arthroscopic shoulder surgery under general anesthesia. However, the time to first pain is significantly longer with anterior suprascapular nerve block. Pain scores at 24 hours postoperatively were significantly lower in the anterior supra scapular nerve block compared to the interscalene block group. Diaphragmatic movements after anterior suprascapular nerve block were also better preserved at both 30 minutes after the block and 24 hours after surgery.
目的:这项前瞻性、随机研究旨在比较肩胛前上神经阻滞与斜角肌间神经阻滞在肩关节镜手术中膈肌麻痹的疗效。方法:52例肩关节镜手术患者前瞻性随机分为斜角肌间神经阻滞组(n=25)和肩胛前上神经阻滞组(n=27)(每组5 mL, 0.5%布比卡因)。所有患者在阻滞完成前(基线)、30分钟和24小时使用超声成像评估同侧膈偏移。术前1小时、术后30-60分钟、术后6小时和24小时分别记录疼痛评分。结果:两组患者均未见完全瘫痪。肩胛前上神经阻滞组膈肌运动部分减少的发生率明显低于斜角肌间神经阻滞组(1例对21例)(P < 0.01)。肩胛前上神经阻滞组26例患者和斜角肌间神经阻滞组4例患者在阻滞30分钟后半膈肌运动下降小于25%。两组疼痛评分相近。而斜角肌间神经阻滞组术后24小时的平均疼痛评分明显高于肩胛前上神经阻滞组(P < 0.05)。肩胛前上神经阻滞组到第一次疼痛阻滞的时间明显长于斜角肌间神经阻滞组(677.04±52.17 min vs 479.2±99.74 min, P < 0.05)。结论:肩胛前上神经阻滞和斜角肌间神经阻滞对全麻下关节镜肩关节手术患者术后镇痛均有较好的临床效果。然而，肩胛上神经阻滞患者出现首次疼痛的时间明显延长。术后24小时肩胛前上神经阻滞组疼痛评分明显低于斜角肌间神经阻滞组。肩胛前上神经阻滞后的膈肌运动在阻滞后30分钟和术后24小时都能得到较好的保存。证据等级:I级，治疗性研究。
期刊介绍：
Acta Orthopaedica et Traumatologica Turcica (AOTT) is an international, scientific, open access periodical published in accordance with independent, unbiased, and double-blinded peer-review principles. The journal is the official publication of the Turkish Association of Orthopaedics and Traumatology, and Turkish Society of Orthopaedics and Traumatology. It is published bimonthly in January, March, May, July, September, and November. The publication language of the journal is English.
The aim of the journal is to publish original studies of the highest scientific and clinical value in orthopedics, traumatology, and related disciplines. The scope of the journal includes but not limited to diagnostic, treatment, and prevention methods related to orthopedics and traumatology. Acta Orthopaedica et Traumatologica Turcica publishes clinical and basic research articles, case reports, personal clinical and technical notes, systematic reviews and meta-analyses and letters to the Editor. Proceedings of scientific meetings are also considered for publication.
The target audience of the journal includes healthcare professionals, physicians, and researchers who are interested or working in orthopedics and traumatology field, and related disciplines.
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