【原】【罂粟摘要】臂丛神经阻滞后的反跳痛和术后疼痛状况与全身麻醉相比-一项观察性研究

臂丛神经阻滞后的反跳痛和术后疼痛状况与全身麻醉相比-一项观察性研究

贵州医科大学          麻醉与心脏电生理课题组

翻译：马燕艳      编辑：田明德    审校：曹莹

目的：区域麻醉的优点是减少了对全身镇痛的需求，因此，有可能减少不良副作用。然而，随着感觉神经阻滞的结束，许多患者报告需要使用阿片类药物治疗的剧烈疼痛，并且通常会损害最初的阿片类药物保留效果。本研究旨在表明与全身麻醉 （GA） 相比，臂丛神经麻醉 （RA） 术后疼痛状况和反跳痛现象。

设计：单中心观察性、分层队列研究。

机构： 该研究于 2020 年 5 月至 2022 年 9 月在马尔堡大学医院进行。

参与者： 132 例接受择期手部和前臂手术的患者被纳入本研究。

干预措施： RA 组通过腋窝入路接受超声引导下的臂丛神经麻醉，使用 30 mL 1% 丙胺卡因和 10 mL 0.2% 罗哌卡因。GA 组接受全身麻醉。

主要结局指标： 主要终点为术后 24 h 内综合疼痛评分 （IPS）。次要终点是疼痛评分（NRS 0-10）、吗啡用量、患者满意度、恢复质量和阿片类药物相关副作用。

结果： 132 例患者，其中 66 例接受臂丛神经阻滞，66 例接受全身麻醉。RA 后，手术后 （p < .001） 和麻醉后监护病房间隔 （p < .001） 显着降低 IPS，但在病房 3 小时后趋于平衡。没有检测到疼痛评分的超调或阿片类药物消耗的增加。两组患者满意度和术后恢复情况相当。

结论：RA组的IPS和NRS最初较低，随着区块的衰落而增加，直到与GA组相等，此后相等。尽管在此阶段满足了反跳痛的各种定义，但区域麻醉的阿片类药物保留作用并未被它抵消。不受控制的剧烈疼痛发作的发生率在两组之间没有差异。在这种情况下，我们没有发现反跳性疼痛的临床意义，因为RA组在任何时间点都没有表现出比GA组更高的疼痛评分。

原始文献来源： Schubert AK, Wiesmann T, Volberg C, Riecke J, Schneider A, Wulf H, Dinges HC. Rebound pain and postoperative pain profile following brachial plexus block compared to general anaesthesia-An observational study. Acta Anaesthesiol Scand. 2023 Nov;67(10):1414-1422. doi: 10.1111/aas.14318.

Rebound pain and postoperative pain profile following brachial plexus block compared to general anaesthesia-An observational study

Background: Regional anaesthesia has the benefit of reducing the need for systemic analgesia and therefore, potentially reducing undesired side effects. With the end of the sensory nerve block however, many patients report severe pain that requires therapy with opioids and often compromise the initial opioid sparing effect. This study aimed to characterise the postoperative pain profile and the phenomenon of rebound pain after axillary brachial plexus anaesthesia (RA) compared to general anaesthesia (GA).

Design: Single-centre observational, stratified cohort study.

Setting: The study was conducted at University Hospital Marburg from May 2020 until September 2022.

Participants: One hundred thirty-two patients receiving elective hand and forearm surgery were enrolled in this study.

Interventions: Group RA received ultrasound-guided brachial plexus anaesthesia via the axillary approach with 30 mL of prilocaine 1% and 10 mL ropivacaine 0.2%. Group GA received balanced or total intravenous general anaesthesia.

Main outcome measures: Primary endpoint were integrated pain scores (IPS) within 24 h postoperatively. Secondary endpoints were pain scores (NRS 0-10), morphine equivalents, patient satisfaction, quality of recovery and opioid-related side effects.

Results: One hundred thirty-two patients were analysed of which 66 patients received brachial plexus block and 66 patients received general anaesthesia. Following RA significantly lower IPS were seen directly after surgery (p < .001) and during the post-anaesthesia care unit interval (p < .001) but equalised after 3 h at the ward. No overshoot in pain scores or increased opioid consumption could be detected. Patient satisfaction and postoperative recovery were comparable between both groups.

Conclusion: The IPS and NRS was initially lower in the RA group, increased with fading of the block until equal to the GA group and equal thereafter. Although various definitions of rebound pain were met during this phase, the opioid sparing effect of regional anaesthesia was not counteracted by it. The incidence of episodes with uncontrolled, severe pain did not differ between groups. We found no clinical implications of rebound pain in this setting, since the RA group did not show higher pain scores than the GA group at any time point.