摘要
目的 探讨关节镜下肩袖修复术后关节周围鸡尾酒注射镇痛的效果及安全性.方法 2020年6月至2021年5月山东大学齐鲁医院(青岛)收治120例肩袖撕裂接受关节镜下肩袖修复术治疗的患者,男45例、女75例,年龄(61.35±5.75)岁(范围57～67岁),左侧肩关节58例、右侧肩关节62例.随机分为鸡尾酒注射组(接受关节周围注射罗哌卡因+吗啡+肾上腺素+复方倍他米松复方制剂)和镇痛泵组(应用镇痛泵),每组60例.围手术期及术后镇痛均采用标准化方案.在手术当日、术后第1天和第2天、出院当日以及术后2周和6周时记录疼痛视觉模拟评分(visual analogue scale,VAS)和肩关节活动范围.并记录术后临时镇痛剂(塞来昔布)的应用次数,以及鸡尾酒注射和镇痛泵应用的不良反应.结果 两组患者的年龄、性别、手术时间、体质指数(body mass index,BMI)、美国麻醉医师协会(American Society of Anes-thesiologists,ASA)分级、术前VAS评分、手术时间、术后住院时间、肩袖撕裂面积和术中使用锚钉数量的差异均无统计学意义(P＞0.05).鸡尾酒注射组患者术后VAS评分更低、肩关节活动度更大.与镇痛泵组相比,鸡尾酒注射组术后6、12 h和前24 h的临时镇痛剂应用次数减少.术后12 h鸡尾酒注射组VAS评分为3(3,4)分,低于镇痛泵组为5(5,6)分,差异有统计学意义(Z=143.004,P=0.003);术后18 h鸡尾酒注射组VAS评分出现反跳,VAS评分上升至4(3,4)分,但仍低于镇痛泵组的5(4,5)分;术后24～48 h鸡尾酒注射组VAS评分与镇痛泵组的差异无统计学意义(P＞0.05).术后12 h疼痛VAS评分的logistic回归分析显示,应用关节周围鸡尾酒注射是术后12 h较低VAS评分的独立预测因素[OR=4.125,95％CI(2.672,4.328),P=0.015],而患者的年龄、BMI、ASA分级、术前VAS评分、手术时间、肩袖撕裂面积、锚钉使用数量不是术后12 h疼痛VAS评分的独立预测因素(P＞0.05).术后24 h疼痛VAS评分的logistic回归分析结果显示,所有因素均不是术后24 h疼痛VAS评分升高的独立预测因素(P＞0.05).结论 关节周围鸡尾酒注射可大幅减少关节镜下肩袖修复术后镇痛药物的用量,并提高患者的满意度.
Abstract
Objective To evaluate the efficacy and safety of periarticular cocktail injection analgesia after arthroscopic rotator cuff repair surgery.Methods From June 2020 to May 2021,120 patients with rotator cuff tears were treated at Shandong University Qilu Hospital(Qingdao)with arthroscopic rotator cuff repair surgery.The cohort included 45 males and 75 females,aged 61.35±5.75 years(range 57-67 years),with 58 cases involving the left shoulder joint and 62 cases involving the right shoul-derjoint.Patients were randomly divided into a cocktail group(receiving periarticular injections of ropivacaine,morphine,adrena-line,and compound betamethasone)and an analgesic pump group(using an analgesic pump).Standardized protocols were used for perioperative and postoperative analgesia.The visual analog scale(VAS)of pain and shoulder joint range of motion were recorded on the day of surgery,the first and second postoperative days,the day of discharge,and at follow-up at 2 and 6 weeks.The postop-erative demand for temporary analgesics(celecoxib),as well as adverse reactions to cocktail injections and analgesic pump applica-tions were also recorded.Results There were no statistically significant differences in age,gender,surgical time,body mass in-dex(BMI),American Society of Anesthesiologists(ASA)classification,preoperative VAS score,surgical time,postoperative hospi-tal stay,rotator cuff tear area,and intraoperative anchor number between the two groups of patients(P＞0.05).Patients who re-ceived periarticular cocktail injections performed better in terms of postoperative VAS scores and functional recovery.Compared with the analgesic pump group,the temporary use of analgesics in the cocktail group was significantly reduced at 6,12,and 24 hours after surgery.After 12 hours of surgery,the cocktail group received 3(3,4)points and the analgesic pump group received 5(5,6)points,with statistically significant differences(Z=143.004,P=0.003);18 hours after surgery,the VAS score in the cocktail group showed a rebound,rising to 4(3,4)points,but still lower than 5(4,5)points in the analgesic pump group.There was no sig-nificant difference in VAS scores between the cocktail group and the analgesic pump group at 24-48 hours after surgery(P＞0.05).The use of cocktail injections was associated with lower VAS scores at 12 hours post-surgery(OR=4.125;95％CI:2.672,4.328;P=0.015).There is no correlation between age,BM,ASA,pre-operative VAS,surgical time,rotator cuff tear size,number of anchor bolts used,and postoperative VAS score at 12 hours.Multivariate regression analysis of postoperative 24-hour VAS scores showed that no factors were associated with postoperative 24-hour VAS scores.Conclusion Periarticular cocktail injection can signifi-cantly reduce the need for postoperative pain relief and improve patient satisfaction,without posing significant risks after ar-throscopic rotator cuff repair surgery.
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