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肩关节置换术中脂质体布比卡因与非脂质体布比卡因在单次肌间沟阻滞的比较
贵州医科大学 麻醉与心脏电生理课题组 翻译：赵游霄 编辑：杨荣峰 审校：曹莹 区域麻醉是全肩关节置换术 (TSA) 中多模式疼痛控制的重要组成部分，存在多种肌间沟阻滞麻醉选择，包括非脂质体肌间沟布比卡因 (NLIB) 和脂质体肌间沟布比卡因 (LIB)。当前研究的目的是比较接受LIB 或 NLIB 的 TSA 患者术后 48 小时内的疼痛控制和阿片类药物消耗量。 这是一项在单一学术医疗中心进行的回顾性队列研究，包括 2016 年至 2020 年间连续接受住院（>23 小时住院）初级解剖或反向 TSA 的患者，这些患者接受 LIB 或 NLIB来进行围手术期疼痛控制。收集围手术期患者的结果，包括疼痛等级和阿片类药物的使用情况，以及 30 天和 90 天的急诊就诊或再入院情况。主要结局是术后疼痛和阿片类药物的使用。 总体而言，本研究纳入了 489 名患者（316 名 LIB 和 173 名 NLIB）。术后 3、6、12 和 48 小时的疼痛评分无统计学显著差异（均 p>0.05）。然而，LIB 组在术后 24 小时和 36 小时疼痛评分有所改善（均 p<0.05）。在调整术前疼痛和基线阿片类药物使用后，两个麻醉组之间严重术后疼痛（定义为 9 或 10 NRS-11 评分）的发生率没有差异（OR：1.25；95% CI：0.57- 2.74；p=0.57)。总体而言，接受 LIB 的患者中有 99/316 (31.3%) 不需要任何术后阿片类药物，而接受 NLIB 的患者中有 38/173 (22.0%) 不需要任何术后阿片类药物；然而，在调整先前阿片类药物使用和术前疼痛后，这种差异并不具有统计学意义（p = 0.33）。在住院期间，发现术后总的吗啡当量和日平均当量的消耗无统计学显著差异（均 p>0.05）。最后，30 天和 90 天的急诊就诊率或再入院率没有显著差异（均p>0.05）。
LIB 和 NLIB 显示患者在术后 24小时和 36 小时报告的疼痛评分存在差异，尽管这些未达到临床意义。住院期间阿片类药物消耗量无统计学显著差异，其中包括住院期间阿片类药物使用量、总吗啡当量和日平均吗啡当量。此外，30 和90 天的急诊就诊率或再入院率没有观察到差异。 原始文献来源：Lorentz, S., Levin, J. M., Warren, E., Hurley, E. T., Mills, F. B., Crook, B. S., Poehlein, E., Green, C. L., Bullock, W. M., Gadsden, J. C., Klifto, C. S., & Anakwenze, O. (2024). Single Shot Interscalene Block with Liposomal Bupivacaine versus Non-Liposomal Bupivacaine in Shoulder Arthroplasty. Journal of Shoulder and Elbow Surgery.https:///10.1016/j.jse.2024.05.046 Single Shot Interscalene Block with Liposomal Bupivacaine versus Non-Liposomal Bupivacaine in Shoulder Arthroplasty ABSTRACT Background: Regional anesthesia is a valuable component of multimodal pain control in total shoulder arthroplasty (TSA), and multiple interscalene block anesthetic options exist, including non-liposomal interscalene bupivacaine (NLIB) and liposomal interscalene bupivacaine (LIB). The purpose of the current of study was to compare pain control and opioid consumption within 48 hours postoperative in those undergoing TSA with either LIB or NLIB. Methods: This was a retrospective cohort study at a single academic medical center including consecutive patients undergoing inpatient (>23-hour hospitalization) primary anatomic or reverse TSA from 2016 to 2020 who received either LIB or a NLIB for perioperative pain control. Perioperative patient outcomes were collected including pain levels and opioid usage, as well as 30- and 90-day ED visits or readmissions. The primary outcome was postoperative pain and opioid use. Results: Overall, 489 patients were included in this study (316 LIB and 173 NLIB). Pain scores at 3, 6, 12, and 48 hours postoperatively were not statistically significantly different (p>0.05 for all). However, the LIB group had improved pain scores at 24- and 36-hours postoperative (p<0.05 all). There was no difference in the incidence of severe postoperative pain, defined as a 9 or 10 NRS-11 score, between the two anesthesia groups after adjusting for preoperative pain and baseline opioid use (OR: 1.25; 95% CI: 0.57-2.74; p=0.57). Overall, 99/316 (31.3%) of patients receiving LIB did not require any postoperative opioids compared with 38/173 (22.0%) receiving NLIB; however, this difference was not statistically significant after adjusting for prior opioid use and preoperative pain (p=0.33). No statistically significant differences in postoperative total morphine equivalents or mean daily morphine equivalents consumed between the groups were found during their hospital stays (p>0.05 for both). Finally, no significant differences in 30- and 90-day ED visits or readmission rates were found (all p>0.05). Conclusion: LIB and NLIB demonstrated differences in patient reported pain scores at 24and 36-hours post operation, although these did not reach clinical significance. There were no statistically significant differences in opioid consumption during the hospital stay, including opioid use, total morphine equivalents and daily mean morphine equivalents consumed during the hospital stay. Additionally, no differences were observed in 30- and 90-day ED visits or readmission rates. END |
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来自： 罂粟花anesthGH > 《待分类》
