斜角肌间阻滞在骨科治疗肩关节创伤中的镇痛作用:单剂量布比卡因脂质体与神经周导管。

IF 1.5 Q3 ANESTHESIOLOGY Local and Regional Anesthesia Pub Date : 2021-12-07 eCollection Date: 2021-01-01 DOI:10.2147/LRA.S303455
Andrzej P Kwater, Nadia Hernandez, Carlos Artime, Johanna Blair de Haan
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引用次数: 1

摘要

背景:斜角肌间臂丛阻滞常用于肩关节手术患者的围手术期镇痛,以优化恢复,减少阿片类药物的消耗,并缩短总住院时间。应用神经周围斜角肌间留置导管可提供延长的镇痛,并可有效地处理肩部大手术后的严重术后疼痛。目前,斜角肌间阻滞延长镇痛的唯一替代神经周围导管涉及布比卡因脂质体的神经周围浸润。然而,关于肩关节手术中使用斜角肌间脂质体布比卡因的整体镇痛效果,发表的数据有限。方法:我们对43例急性创伤患者进行回顾性分析,这些患者接受了大肩关节手术,并通过围手术期斜角肌间臂丛阻滞,留置连续导管或单剂量布比卡因脂质体进行延长镇痛,以确定是否可以达到类似的镇痛效果。主要研究结果为术后疼痛评分和阿片类药物消耗。由于能够滴定和滴注局麻达到预期的临床效果,我们假设使用连续导管技术时阿片类药物消耗和疼痛评分会更低。结果:经过统计分析,我们的结果显示,在术后48小时内,两种技术在阿片类药物消耗和数值疼痛评分方面没有显著差异,但确实注意到接受神经周围斜角肌间连续导尿管的患者并发症发生率更高。次要结果显示,使用留置导尿管完成局部阻滞手术所需的时间增加。结论:布比卡因脂质体联合斜角肌间臂丛阻滞可能是一种可行的替代留置连续导管的方法,可为大肩关节手术患者提供延长的镇痛。
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Interscalene Block for Analgesia in Orthopedic Treatment of Shoulder Trauma: Single-Dose Liposomal Bupivacaine versus Perineural Catheter.

Background: Interscalene brachial plexus block is frequently utilized to provide perioperative analgesia to patients undergoing shoulder surgery to optimize recovery, minimize opioid consumption, and decrease overall hospital length of stay. The use of an indwelling perineural interscalene catheter provides extended analgesia and is efficacious in managing severe postoperative pain following major shoulder surgery. Currently, the only alternative to perineural catheters for extended analgesia with interscalene block involves the perineural infiltration of liposomal bupivacaine. However, there is limited published data regarding the overall analgesic effectiveness of using interscalene liposomal bupivacaine in the setting of shoulder surgery.

Methods: We performed a retrospective review of 43 patients in the acute trauma setting who underwent major shoulder surgery and received extended analgesia via perioperative interscalene brachial plexus block with either an indwelling continuous catheter or single-dose liposomal bupivacaine to determine if comparable analgesia can be achieved. The primary outcomes of interest were postoperative pain scores and opioid consumption. Due to the ability to titrate and bolus local anesthetic infusions to a desired clinical effect, we hypothesized that opioid consumption and pain scores would be lower when using the continuous catheter technique.

Results: After statistical analysis, our results demonstrated no significant difference between the two techniques in regards to opioid consumption as well as numeric pain scores during the 48-hour postoperative period, but did note a higher rate of complications with patients who received perineural interscalene continuous catheters. Secondary outcomes showed an increase in time required to complete the regional block procedure with the use of indwelling catheters.

Conclusion: Interscalene brachial plexus block with liposomal bupivacaine may be a viable alternative to indwelling continuous catheters for providing extended analgesia in patients undergoing major shoulder surgery.

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来源期刊
CiteScore
6.30
自引率
0.00%
发文量
12
审稿时长
16 weeks
期刊最新文献
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