“鸡尾酒”疗法对肩袖损伤修补术后镇痛的疗效影响

Effect of cocktail injection therapy on postoperative analgesia of rotator cuff injury repair

目的评估由罗哌卡因和复方倍他米松配制的“鸡尾酒”在肩袖损伤术后的镇痛效果,评价其安全有效性。方法对2019年3月至2020年6月期间在东部战区总医院行关节镜下肩袖损伤修补术的160例患者进行前瞻性双盲随机研究,所有患者按随机数字表法分为“鸡尾酒”疗法组和对照组,每组80例。“鸡尾酒”疗法组在术后向肩峰下间隙注射由罗哌卡因和复方倍他米松配制的“鸡尾酒”,对照组注射罗帕卡因。记录患者术前、术后6、12、24、48 h及术后1、2周患者VAS评分;对患者术前和术后2、4、12、24周Constant-Murley和UCLA评分进行评估分析,并通过术前和术后12周MRI检查观察肩袖修补术后愈合情况。结果“鸡尾酒”疗法组VAS评分在术后12 h至术后第2周明显低于对照组评分(P<0.05),在术后12 h后,VAS评分在“鸡尾酒”疗法组[(2.25±1.12)分]与对照组[(3.18±0.68)分]开始出现明显差异(P<0.05);术后第4周的Constant-Murley评分在对照组[(70.35±8.45)分]与“鸡尾酒”疗法组[(78.25±9.25)分]相比差异有统计学意义(P<0.05)、UCLA评分在对照组[(20.65±6.10)分]与“鸡尾酒”疗法组[(28.95±6.78)分]相比差异有统计学意义(P<0.05),这些评分在术后3个月后差异无统计学意义(P>0.05);MRI检查提示2组患者肩袖在术后12周均愈合良好,无并发症发生。结论由罗哌卡因和复方倍他米松配制的“鸡尾酒”在肩袖损伤术后镇痛效果优良,可在术后早期明显改善患者肩关节疼痛及功能,从而在不增加术后并发症的同时有助于术后早期的康复。

Objective To evaluate the safety and effectiveness of"cocktail injection"prepared by ropivacaine and compound betamethasone in the postoperative analgesic of rotator cuff injury repair.Methods A prospective double-blind randomized study was conducted on 160 patients who underwent arthroscopic supraspinatus rotator cuff injury repair in our department from March 2019 to June 2020.All patients were injected with cocktail injection in the subacromial space after arthroscopy surgery.Cocktail injection therapy included ropivacaine,the experimental group and the control group with or without compound betamethasone respectively.VAS scores were recorded before surgery,and 6 h,12 h,24 h,48 h,1 week,2 weeks after surgery.Constant-Murley and UCLA scores were evaluated before surgery and at 2 weeks,4 weeks,3 months and 6 months after surgery,and the incidence of complications was observed.Results VAS score of the experimental group was lower than that of the control group during 12 hours to 2 weeks postoperatively(P<0.05).12 h after surgery,VAS scores in the experimental group(2.25±1.12)began to show significant differences compared with the control group(3.18±0.68).Constant-Murley score of the control group(70.35±8.45)was significantly different from that of the experimental group(78.25±9.25)at week 4 after surgery(P<0.05).UCLA scores in the control group(20.65±6.10)were significantly different from those in the experimental group(28.95±6.78)(P<0.05),but there was no significant difference in these scores 3 months after surgery(P>0.05).MRI examination showed that the rotator cuff in both groups healed 12 weeks after surgery without complications.Conclusion The"cocktail injection"therapy composed of ropivacaine and compound betamethasone has an excellent analgesic effect after rotator cuff injury repair,which does not increase postoperative complications and contributes to early postoperative recovery.