[1]侯赛楠,王爱荣,丁苏婉.曲马多复合罗哌卡因臂丛神经阻滞对全麻肩关节镜手术患者术后镇痛效果的影响[J].陕西医学杂志,2024,(9):1206-1209,1214.[doi:DOI:10.3969/j.issn.1000-7377.2024.09.011]
　HOU Sainan,WANG Airong,DING Suwan.Effect of tramadol combined with ropivacaine brachial plexus block on postoperative analgesia in patients undergoing arthroscopic shoulder surgery under general anesthesia[J].,2024,(9):1206-1209,1214.[doi:DOI:10.3969/j.issn.1000-7377.2024.09.011]
点击复制

曲马多复合罗哌卡因臂丛神经阻滞对全麻肩关节镜手术患者术后镇痛效果的影响
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2024年9期
页码:
1206-1209,1214
栏目:
临床研究
出版日期:
2024-09-05

文章信息/Info

Title:
Effect of tramadol combined with ropivacaine brachial plexus block on postoperative analgesia in patients undergoing arthroscopic shoulder surgery under general anesthesia
作者:
侯赛楠; 王爱荣; 丁苏婉
(北京市和平里医院麻醉科,北京 100013)
Author(s):
HOU Sainan; WANG Airong; DING Suwan
(Department of Anesthesiology,Beijing Hepingli Hospital,Beijing 100013,China)
关键词:
肩关节镜;  臂丛神经阻滞;  罗哌卡因;  曲马多;  镇痛;  炎症
Keywords:
Shoulder arthroscopy;  Brachial plexus block;  Ropivacaine;  Tramadol;  Analgesia;  Inflammation
分类号:
R 614.2
DOI:
DOI:10.3969/j.issn.1000-7377.2024.09.011
文献标志码:
A
摘要:
目的:探讨肩关节镜手术患者臂丛神经阻滞中使用曲马多复合罗哌卡因对术后镇痛的影响。方法:将行肩关节镜手术的患者105例随机分为对照组(52例)和观察组(53例)。两组全麻前均实施臂丛神经阻滞,其中对照组予以0.3%罗哌卡因,观察组予以0.3%罗哌卡因+曲马多100 mg。两组术后均予以自控镇痛。比较两组术后4、8、12、24 h疼痛评分,术后24 h镇痛泵有效按压次数以及补救镇痛率。比较两组术后24 h时15项恢复质量评估表(QoR-15)评分和肩关节活动度。于术前和术后24 h,对患者血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)水平进行测定。统计两组术后24 h不良反应情况。结果:相较于对照组,术后各时间点观察组VAS评分更低,且术后24 h观察组镇痛泵有效按压次数更少(均P<0.05)。两组补救镇痛率比较无统计学差异(P>0.05)。相较于对照组,观察组术后24 h QoR-15评分更高,且肩关节前屈活动度和外展活动度均更大(均P<0.05)。相较于术前,术后24 h两组血清CRP和IL-6水平升高,且观察组低于对照组(均P<0.05)。相较于对照组,术后24 h不良反应观察组发生率更低(P<0.05)。结论:肩关节镜术行臂丛神经阻滞时使用曲马多复合罗哌卡因可提供较好镇痛效果,缓解患者术后疼痛,减轻炎症,改善肩关节活动度。
Abstract:
Objective:To investigate the effect of tramadol combined with ropivacaine for brachial plexus block on postoperative analgesia in patients undergoing arthroscopic shoulder surgery under general anesthesia.Methods:A total of 105 patients undergoing shoulder arthroscopy were randomly divided into control group(52 cases)and observation group(53 cases).Brachial plexus block was performed in both groups before general anesthesia.The control group was given 0.3% ropivacaine,and the observation group was given 0.3% ropivacaine and tramadol 100 mg.Both groups were given patient-controlled analgesia after operation.The pain scores at 4,8,12,24 hours after operation were compared between the two groups.The effective pressing times of analgesia pump at 24 hours after operation were recorded,and the remedial analgesia rate was counted.The QoR-15 score and shoulder mobility were compared between the two groups at 24 hours after operation.The serum levels of CRP and IL-6 were measured before and 24 hours after operation.The adverse reactions of the two groups at 24 hours after operation were counted.Results:Compared with the control group,the pain score of the observation group was lower at each time point after operation,and the effective pressing times of the analgesic pump in the observation group was less than that in the control group(all P<0.05).There was no significant difference in the rate of remedial analgesia between the two groups(P>0.05).Compared with the control group,the QoR-15 score of the observation group was higher at 24 hours after operation,and the flexion and abduction activities of the shoulder joint were larger(all P<0.05).Compared with pre-operation,at 24 hours after operation,the levels of serum CRP and IL-6 in the two groups increased,but those in the observation group were lower than those in the control group(all P<0.05).The incidence of adverse reactions at 24 hours after operation was lower in the observation group than that in the control group(P<0.05).Conclusion:Tramadol combined with ropivacaine for brachial plexus block in shoulder arthroscopy can provide better analgesic effect,relieve postoperative pain,reduce inflammation and improve shoulder mobility.

参考文献/References:

[1] 韩黄伟,柴发银,巩陈.复元活血汤加减治疗肩袖损伤关节镜术后疼痛气滞血瘀证临床研究[J].陕西中医,2023,44(7):905-908.
[2] DIVELLA M,VETRUGNO L,ORSO D,et al.Which regional anesthesia technique is the best for arthroscopic shoulder surgery in terms of postoperative outcomes? A comprehensive literature review[J].Eur Rev Med Pharmacol Sci,2021,25(2):985-998.
[3] 刘金花,邓莎,许荔,等.超声引导下选择性臂丛神经阻滞辅助肩关节镜围手术期镇痛[J].国际骨科学杂志,2023,44(5):327-331.
[4] WHITE L,REARDON D,DAVIS K,et al.Anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery:A systematic review and meta-analysis of randomized controlled trials[J].J Anesth,2022,36(1):17-25.
[5] 孙芳,董洪智,王朋,等.超声引导不同入路的臂丛神经阻滞联合脑电双频指数监测对肩关节镜下患者的麻醉效果分析[J].临床和实验医学杂志,2023,22(1):102-106.
[6] 李咸鹏,郑煜丽,高晓曼,等.肋锁间隙入路臂丛神经阻滞的研究进展[J].国际麻醉学与复苏杂志,2023,44(9):990-994.
[7] 屈江波,郗东锋,李斌.罗哌卡因复合佐剂应用于臂丛神经麻醉的临床研究[J].山西医药杂志,2021,50(15):2326-2328.
[8] 张倍倍,张爽,陈钱正,等.右美托咪定复合罗哌卡因髂筋膜间隙阻滞用于老年髋关节置换术的镇痛效果及对PI3K-Akt信号通路的影响[J].临床和实验医学杂志,2023,22(17):1901-1904.
[9] 胡斌,赵玉仙,苏惠斌,等.曲马多或地塞米松复合罗哌卡因对臂丛神经阻滞时间的影响[J].临床麻醉学杂志,2013,29(6):583-584.
[10] KLEIF J,WAAGE J,CHRISTENSEN K B,et al.Systematic review of the QoR-15 score,a patient-reported outcome measure measuring quality of recovery after surgery and anaesthesia[J].Br J Anaesth,2018,20(1):28-36.
[11] 李麟,殷国江,祝雨思,等.后路与前外侧路连续肌间沟臂丛神经阻滞对肩关节镜术后镇痛效果比较[J].医学研究杂志,2021,50(6):145-149.
[12] YU D,JIANG J,JIANG Z,et al.Application of ultrasound-guided upper trunk brachial plexus block in observation of lower shoulder surgery[J].Contrast Media Mol Imaging,2022,2022:9168566.
[13] LIM J A,SUNG S Y,LEE J H,et al.Comparison of ultrasound-guided and nerve stimulator-guided interscalene blocks as a sole anesthesia in shoulder arthroscopic rotator cuff repair:A retrospective study[J].Medicine(Baltimore),2020,9(35):21684-21691.
[14] 吴赞情,张阿曼,董补怀.选择性颈神经根阻滞与臂丛神经阻滞在肩关节镜术后镇痛效果的对比研究[J].陕西医学杂志,2019,48(5):639-643.
[15] 叶久敏,卿忠,杨光,等.不同浓度右美托咪定联合罗哌卡因腘动脉与膝关节后囊间隙阻滞用于全膝关节置换镇痛临床研究[J].陕西医学杂志,2020,49(8):1020-1024.
[16] KAKI A M,ALMARAKB W.Post-herniorrhapy infiltration of tramadol versus bupivacaine for postoperative pain relief:A randomized study[J].Ann Saudi Med,2008,28(3):165-168.
[17] 闵光炜,李瑾,王江,等.曲马多对全身麻醉脊柱手术患者红细胞免疫功能、认知功能、拔管反应的影响[J].中国医刊,2023,58(10):1103-1106.
[18] 贺端端,张华,林梓楠,等.曲马多用于全麻苏醒期镇痛的临床回顾性研究[J].中国疼痛医学杂志,2020,26(2):122-127.
[19] WANG J T,CHUNG C C,WHITEHEAD R A,et al.Effects of local tramadol administration on peripheral glutamate-induced nociceptive behaviour in mice[J].Can J Anaesth,2010,57(7):659-663.
[20] FEIGL G C,LITZ R J,MARHOFER P.Anatomy of the brachial plexus and its implications for daily clinical practice:Regional anesthesia is applied anatomy[J].Reg Anesth Pain Med,2020,45(8):620-627.
[21] 熊伟,刘信全,唐连强,等.右美托咪定联合罗哌卡因用于连续肋锁间隙臂丛神经阻滞对前臂或手部手术的术后镇痛效果[J].中国现代医药杂志,2020,22(4):8-13.
[22] 王守立,周晓波,刘福存,等.不同时间点给予帕瑞昔布在肩关节镜术后的镇痛作用[J].中国内镜杂志,2019,25(9):1-6.
[23] 李帛谦.超声引导下神经阻滞复合全麻在肩关节镜手术中的应用[J].中国煤炭工业医学杂志,2021,24(1):33-36.
[24] 刘意来,李彬,陈巍,等.肩关节镜手术联合富血小板血浆注射对肩袖损伤患者炎症因子水平及腱-骨愈合的影响[J].临床和实验医学杂志,2022,21(23):2517-2521.
[25] 吴金龙,许敏,王莉珍,等.环泊酚与丙泊酚对髋关节置换术患者围术期炎症指标和术后恢复情况的影响[J].中国临床保健杂志,2023,26(4):556-559.
[26] 于天雷,苏丽.连续后路肌间沟臂丛神经阻滞和经静脉患者自控镇痛在肩关节镜手术患者中的应用及对预后的影响[J].中国内镜杂志,2022,28(8):1-7.
[27] 徐丁琳,张蕾,祖之慧,等.养精种玉汤对薄型子宫内膜大鼠血清TNF-α、IL-6的影响[J].陕西中医,2024,45(5):583-587.

相似文献/References:

[1]游腾靖.关节镜改良Endobutton结合锚钉双重解剖重建治疗肩锁关节脱位[J].陕西医学杂志,2019,(7):923.

备注/Memo

备注/Memo:
基金项目:北京市卫生健康委员会首都卫生发展科研项目(20215003)
更新日期/Last Update: 2024-09-04