【原】【疼痛专题】关节镜下连续肩胛上神经阻滞与超声引导下连续臂丛上干神经阻滞镇痛效果比较：双盲随机对照试验

新用户9297xop8 2023-08-25 发布于北京

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Comparison of the analgesic efficacy between arthroscopically placed continuous suprascapular nerve block and ultrasound-guided continuous superior trunk block: a double-blinded randomized controlled trial

关节镜下连续肩胛上神经阻滞与超声引导下连续臂丛上干神经阻滞镇痛效果比较：双盲随机对照试验

Background

Single-shot suprascapular nerve block and superior trunk block have been reported to provide a non-inferior analgesic effect after shoulder surgery with a lesser incidence of hemidiaphragmatic paresis compared with interscalene brachial plexus block.

This study hypothesized that continuous suprascapular nerve block provides non-inferior analgesia with minimal effects on diaphragmatic movement compared with continuous superior trunk block in patients undergoing arthroscopic shoulder surgery.

据报道，与肌间沟臂丛神经阻滞相比，单次肩胛上神经阻滞和上干阻滞可在肩部手术后提供不劣的镇痛效果，且膈肌麻痹的发生率较低。本研究假设，对于接受关节镜肩部手术的患者，与连续上干阻滞相比，连续肩胛上神经阻滞可提供非劣效镇痛，且对膈肌运动的影响最小。

Methods

We randomized 100 patients undergoing arthroscopic shoulder surgery between December 2020 and October 2021 into continuous suprascapular nerve block and continuous superior trunk block groups. Before the surgery, patients received either a single-shot superior trunk block or subomohyoid suprascapular nerve block. Thereafter, a superior trunk catheter was inserted by anesthesiologists in patients in the continuous superior trunk block group, and a posterior suprascapular nerve catheter was inserted with arthroscopic assistance during the surgery by surgeon in the continuous suprascapular nerve block group. The primary outcome was the postoperative pain score at postoperative 24 h, and the incidence of hemidiaphragmatic paresis was also compared.

我们将 2020 年 12 月至 2021 年 10 月期间接受关节镜肩部手术的 100 例患者随机分为连续肩胛上神经阻滞组和连续上干阻滞组。手术前，患者接受单次上干阻滞或肩胛下舌骨神经阻滞。此后，连续上干阻滞组由麻醉医师为患者插入上主干导管，连续肩胛上神经阻滞组由外科医生在手术过程中在关节镜辅助下插入后肩胛上神经导管。主要结果是术后24小时的术后疼痛评分，并比较偏侧膈肌麻痹的发生率。

Results

Overall, 98 patients were included in the final analysis. The worst and resting pain scores at postoperative 24 h in the continuous suprascapular nerve block group were inferior compared with those in the continuous superior trunk block group in the test with a noninferiority margin of 1 (worst pain score, mean difference: 0.9, 95% CI 0.1 to 1.7; resting pain score: mean difference: 0.5, 95% CI 0.0 to 1.0). However, the continuous suprascapular nerve block group had a significantly lower incidence of hemidiaphragmatic paresis at postoperative 24 h than the continuous superior trunk block group.

结果：共有98例患者纳入最终分析。试验中，连续肩胛上神经阻滞组术后 24 h 最差疼痛评分和静息疼痛评分均较差，非劣效性界值为 1（最差疼痛评分，平均差：0.9，95%） CI 0.1 至 1.7；静息疼痛评分：平均差：0.5，95% CI 0.0 至 1.0）。然而，持续肩胛上神经阻滞组术后24 h膈肌麻痹的发生率显着低于持续上干阻滞组。

Conclusions

Continuous suprascapular nerve block provides statistically inferior analgesia compared to the continuous superior trunk block; however, the continuous suprascapular nerve block had a minimal effect on the phrenic nerve function.

结论：与连续上干阻滞相比，连续肩胛上神经阻滞的镇痛效果在统计学上较差；然而，连续肩胛上神经阻滞对膈神经功能的影响很小。

重要结果展示：

1. In the non-inferiority test of the primary outcome with a noninferiority margin of 1, the worst numerical rating scale scores at postoperative 24 h in the continuous suprascapular nerve block group were shown to be inferior compared to those in the continuous superior trunk block group (5.2 ± 1.9 and 4.3 ± 2.1, respectively, mean difference: 0.9, 95% CI 0.1 to 1.7, p = 0.370). The resting numerical rating scale scores at postoperative 24 h in the continuous suprascapular nerve block group were inferior compared to those in the continuous superior trunk block group (2.1 ± 1.2 and 1.6 ± 1.3, respectively, mean difference: 0.5, 95% CI 0.0 to 1.0, p = 0.029).

在非劣效性界限为 1 的主要结果的非劣效性检验中，术后 24 小时最差数字评定量表评分与连续上干阻滞组相比，连续肩胛上神经阻滞组的 h 时间较差（分别为 5.2 ± 1.9 和 4.3 ± 2.1，平均差：0.9，95% CI 0.1 至 1.7，p = 0.370）。连续肩胛上神经阻滞组术后24 h静息数值评定量表评分低于连续上干阻滞组（分别为2.1±1.2和1.6±1.3，平均差：0.5，95% CI 0.0～ 1.0，p = 0.029)。

2. The results were not changed after adjusting the stratification variable (surgical strategy) . 调整分层变量（手术策略）后结果没有改变。

3. The general linear model detected a significant effect of the group-by-time interaction on the worst numerical rating scale scores (p = 0.042).

一般线性模型检测到按时间分组的交互作用对最差静息数值评分量表分数有显着影响。

Significant differences were observed in the worst numerical rating scale score at PACU, postoperative 4 h, and at postoperative 24 h between the two groups (p = 0.011, 0.021, and 0.036, respectively); the continuous superior trunk block group further showed a significantly lower worst numerical rating scale score than the continuous suprascapular nerve block group.

两组在 PACU、术后 4 小时和术后 24 小时的最差数字评定量表评分存在显着差异（分别为 p = 0.011、0.021 和 0.036）；连续上干阻滞组进一步表现出比连续肩胛上神经阻滞组显着更低的最差数字评定量表评分。

4. No significant group-by-time interaction was observed in the analysis of resting numerical rating scale scores (p = 0.451).

在静息数值评分量表分数的分析中，没有观察到显着的按时间分组的交互作用（p = 0.451）。

5. There were significant differences in the absolute values of diaphragmatic excursion and the incidences of partial and complete hemidiaphragmatic paresis between the two groups.

两组膈肌偏移绝对值以及部分和完全性膈肌麻痹发生率差异有统计学意义（P<0.001）。