Effect of Ultrasound-Guided Extra-Prevertebral Fascial Suprascapular Nerve and Infraclavicular Brachial Plexus Block on Postoperative Analgesia and Phrenic Nerve Function in Shoulder Arthroscopy: A Pilot Study.

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Journal of Pain Research Pub Date : 2024-12-20 eCollection Date: 2024-01-01 DOI:10.2147/JPR.S487562
Zhenfa Hu, Jinge Hu, Zhangran Ai, Songchao Xu, Huili Li, Ruijuan Guo, Yun Wang
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引用次数: 0

Abstract

Purpose: The suprascapular nerve is situated between the prevertebral fascia and the superficial layer of deep cervical fascia and on the surface of the middle and posterior scalene muscles before it reaches the suprascapular notch. Consequently, we hypothesized that injecting local anesthetics (LAs) there would introduce a new block approach for blocking the suprascapular nerve, ie, extra-prevertebral fascial block. We assessed the postoperative analgesic effect, as well as the incidence of diaphragmatic paralysis 30 minutes after the block.

Methods: 30 patients undergoing elective shoulder arthroscopic rotator cuff repair surgery were recruited in this study. Before the induction of general anesthesia, 15 mL of 0.5% ropivacaine was administered to perform an extra-prevertebral fascia suprascapular nerve block (10 mL) and an infraclavicular brachial plexus block (5 mL, primarily targeting the axillary nerve). All patients received intravenous patient-controlled analgesia (PCA) after surgery. The postoperative pain was scored with Numeric Rating Scale (NRS), along with the opioid consumption in the first 24 h after surgery. The incidence of hemi-diaphragmatic paralysis (HDP) was measured 30 minutes after the block.

Results: All patients received the successful block. The resting NRS pain scores at 1h, 6h, 12h, and 24h postoperatively were 0 [0, 2], 0 [0, 2], 1 [0, 2], and 2 [1, 3], respectively. The oral morphine equivalent (OME) consumption at 24 hours after surgery was 18 [12,30] mg. No patients experienced HDP (complete or partial) 30 minutes after the block.

Conclusion: Compared with the posterior approach, this novel technique is efficient and has a higher success rate of blockade. It eliminates the need for patients to change positions, thereby improving comfort. Additionally, when combined with the infraclavicular brachial plexus block, it can effectively block the suprascapular nerve, providing satisfactory postoperative analgesia without the HDP at 30min after blockade compared to the anterior approach.

超声引导椎前筋膜外肩胛上神经和锁骨下臂丛阻滞对肩关节镜术后镇痛和膈神经功能的影响:一项初步研究。
目的:肩胛上神经位于椎前筋膜和颈深筋膜浅层之间,在到达肩胛上切迹之前位于中、后斜角肌表面。因此,我们假设在那里注射局麻药(LAs)会引入一种新的阻断方法来阻断肩胛上神经,即椎前筋膜外阻滞。我们评估了术后镇痛效果,以及阻滞后30分钟膈肌麻痹的发生率。方法:选取30例择期肩关节镜下肩袖修复术患者。全麻诱导前,给予15 mL 0.5%罗哌卡因进行椎前筋膜外肩胛上神经阻滞(10 mL)和锁骨下臂丛神经阻滞(5 mL,主要针对腋窝神经)。所有患者术后均行静脉自控镇痛(PCA)。采用数字评定量表(NRS)对术后疼痛进行评分,同时记录术后24小时内阿片类药物的使用情况。阻滞30分钟后测量半膈肌麻痹(HDP)的发生率。结果:所有患者均获得成功阻滞。术后1h、6h、12h、24h静息NRS疼痛评分分别为0[0,2]、0[0,2]、1[0,2]、2[1,3]。术后24小时口服吗啡当量(OME)为18 [12,30]mg。阻滞后30分钟没有患者出现HDP(完全或部分)。结论:与后路入路相比,该方法有效,封堵成功率高。它消除了患者改变体位的需要,从而提高了舒适度。此外,与锁骨下臂丛阻滞联合时,可有效阻断肩胛上神经,与前路相比,阻断后30min无HDP的术后镇痛效果较好。
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来源期刊
Journal of Pain Research
Journal of Pain Research CLINICAL NEUROLOGY-
CiteScore
4.50
自引率
3.70%
发文量
411
审稿时长
16 weeks
期刊介绍: Journal of Pain Research is an international, peer-reviewed, open access journal that welcomes laboratory and clinical findings in the fields of pain research and the prevention and management of pain. Original research, reviews, symposium reports, hypothesis formation and commentaries are all considered for publication. Additionally, the journal now welcomes the submission of pain-policy-related editorials and commentaries, particularly in regard to ethical, regulatory, forensic, and other legal issues in pain medicine, and to the education of pain practitioners and researchers.
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