肩胛上神经阻滞联合镇痛在肩关节镜下肩袖修复术疼痛管理中的应用

Efficacy of pain management for suprascapular nerve block analgesia in rotator cuff repair with arthroscopic surgery

目的观察在神经刺激定位仪引导下肩胛上神经阻滞联合镇痛对关节镜下肩袖修复术后早期的镇痛效果。方法将2015年1月至2016年9月45例于本院行关节镜下肩袖损伤修复术的患者随机分为治疗组(23例)与对照组(22例),治疗组采用术前神经刺激定位仪引导下肩胛上神经阻滞+术后静脉自控镇痛泵进行镇痛,对照组术后单纯采用静脉自控镇痛泵。所有患者分别记录术后6、12、24、48小时静息状态下的视觉模拟评分法(visual analogue scale,VAS)疼痛评分和术后12、24、48小时运动状态下的VAS疼痛评分,同时记录术后选择性镇痛药物吗啡的用量及其不良反应的发生情况。结果治疗组患者术后6、12小时静息状态下VAS评分低于对照组,差异有显著性(P<0.05);术后24、48小时静息状态下VAS评分与对照组比较,差异无显著性(P>0.05);治疗组术后12、24、48小时运动状态下VAS评分明显低于对照组,差异有显著性(P<0.05)。治疗组术后吗啡的使用量及不良反应发生率明显低于对照组,差异有显著性(P<0.05)。结论肩胛上神经阻滞联合静脉自控镇痛泵镇痛对于关节镜下肩袖修复术围术期的镇痛疗效明显优于单纯静脉自控镇痛泵,可有效减轻术后疼痛并促进关节功能早期恢复,降低术后选择性镇痛药物的使用率及药物相关不良反应的发生率。

Objective This study was to evaluate the analgesic effect of the early postoperative with the suprascapular nerve block under the nerve stimulator and combined analgesia. Method In the present prospective, randomized clinical study, 43 patients were divided into two groups：23 patients （treatment group） were treated with preoperative nerve stimulation locator guided suprascapular nerve block ＋ postoperative analgesia pump and 22 patients （control group） were treated with intravenous analgesia pump after arthroscopic rotator cuff repair.Patient pain levels were measured using the visual analog scale （VAS） at 6, 12, 24, and 48h after surgery at the resting state and 12, 24, 48h after surgery at motion. At the same time, the dosage of morphine and the incidence of adverse reactions were recorded. Result Two groups of patients with postoperative 6 h, 12 h resting state of VAS score lower than the control group, the difference was statistically significant （P〈0.05）. The treatment group with postoperative 24 h, 48 h after resting state of VAS scores compared with control group,there was no statistically significant difference （P〉0.05）; treatment group after 12 h, 24 h, 48 h movement state of VAS score significantly lower than the control group, the difference was statistically significant （P〈0.05）. The treatment group of postoperative morphine consumption and the incidence of adverse reactions obviously lower than the control group, the difference was statistically significant （P〈 0.05）. Conclusion The effect of the combined analgesia with the suprascapular nerve block is superior to that of the simple intravenous analgesia pump, which can reduce the postoperative pain and promote the early recovery of joint function, and reduce the incidence of postoperative selective analgesic drugs and drug related adverse reactions.