{"title":"肩袖修复术的多模式镇痛应根据手术位置、复杂程度和患者的合并症进行个体化。","authors":"","doi":"10.1016/j.arthro.2024.06.010","DOIUrl":null,"url":null,"abstract":"<div><div>Multimodal analgesia in arthroscopic rotator cuff surgery is commonly used for pain control and to reduce opioid consumption in the early postoperative time and the days following. Indeed, the combination of local anesthetic peripheral nerve blocks and systemic or oral analgesics ensures a better outcome than the isolated use of nonsteroidal anti-inflammatory drugs. In particular, intrascalene block has significant advantages in more complex procedures involving the anterior aspect of the shoulder. However, intrascalene block should be discouraged under conditions of respiratory comorbidity such as severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. In such cases, a multimodal approach based on periarticular infiltration analgesia combined with pharmacologic therapies can ensure excellent pain control with limited use of opioids in the immediate postoperative period. When selecting the best therapeutic combination, it is essential to consider factors that can determine the best balance between safety and effectiveness, such as the complexity of the surgical procedure, preoperative pain, and any comorbidities that could contraindicate the use of certain medications or that could be negatively affected by potential complications or side effects of the analgesic therapy.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Editorial Commentary: Multimodal Analgesia for Rotator Cuff Repair Should Be Individualized Based on Surgical Location and Complexity and Patient Comorbidity\",\"authors\":\"\",\"doi\":\"10.1016/j.arthro.2024.06.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>Multimodal analgesia in arthroscopic rotator cuff surgery is commonly used for pain control and to reduce opioid consumption in the early postoperative time and the days following. Indeed, the combination of local anesthetic peripheral nerve blocks and systemic or oral analgesics ensures a better outcome than the isolated use of nonsteroidal anti-inflammatory drugs. In particular, intrascalene block has significant advantages in more complex procedures involving the anterior aspect of the shoulder. However, intrascalene block should be discouraged under conditions of respiratory comorbidity such as severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. In such cases, a multimodal approach based on periarticular infiltration analgesia combined with pharmacologic therapies can ensure excellent pain control with limited use of opioids in the immediate postoperative period. When selecting the best therapeutic combination, it is essential to consider factors that can determine the best balance between safety and effectiveness, such as the complexity of the surgical procedure, preoperative pain, and any comorbidities that could contraindicate the use of certain medications or that could be negatively affected by potential complications or side effects of the analgesic therapy.</div></div>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0749806324004444\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0749806324004444","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Editorial Commentary: Multimodal Analgesia for Rotator Cuff Repair Should Be Individualized Based on Surgical Location and Complexity and Patient Comorbidity
Multimodal analgesia in arthroscopic rotator cuff surgery is commonly used for pain control and to reduce opioid consumption in the early postoperative time and the days following. Indeed, the combination of local anesthetic peripheral nerve blocks and systemic or oral analgesics ensures a better outcome than the isolated use of nonsteroidal anti-inflammatory drugs. In particular, intrascalene block has significant advantages in more complex procedures involving the anterior aspect of the shoulder. However, intrascalene block should be discouraged under conditions of respiratory comorbidity such as severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. In such cases, a multimodal approach based on periarticular infiltration analgesia combined with pharmacologic therapies can ensure excellent pain control with limited use of opioids in the immediate postoperative period. When selecting the best therapeutic combination, it is essential to consider factors that can determine the best balance between safety and effectiveness, such as the complexity of the surgical procedure, preoperative pain, and any comorbidities that could contraindicate the use of certain medications or that could be negatively affected by potential complications or side effects of the analgesic therapy.
期刊介绍:
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.