目的:本研究的目的是探讨多模式镇痛是否能减少肩关节镜手术患者术后阿片类药物的使用。
方法:对2022年10月至2023年11月在我院接受肩峰下撞击综合征的患者进行回顾性分析。根据术后疼痛管理方法将患者分为观察组和对照组。对照组给予静脉自控电子镇痛(舒芬太尼注射液1μg/kg+布托啡诺注射液4mg+0.9%NaCl注射液100mL),观察组采用多模式镇痛(罗哌卡因肩峰下泵3mL/h,联合口服塞来昔布和对乙酰氨基酚)。术前和术后各个时间点记录视觉模拟量表(VAS)评分,和阿片类药物的使用,住院时间,比较两组术后1周内镇痛相关并发症。36项简短形式健康调查(SF-36)得分和Constant-Murley得分(CMS),还在治疗后1天和1周进行评估。
结果:本研究纳入了123例患者,观察组66例,对照组66例。在对照组中,有46名男性和20名女性,平均年龄55.47±11.42岁,观察组男性44例,女性22例,平均年龄56.13±12.19岁观察组在8h(T1)时一直报告疼痛强度明显低于对照组,24(T2),术后48h(T3)(p<0.05)。此外,观察组阿片类药物使用率和并发症发生率明显低于对照组(p<0.05)。观察组治疗1周后SF-36评分和CMS评分明显高于对照组(p<0.05)。
结论:肩关节镜检查后,多模式镇痛有效减少阿片类药物的消耗,降低并发症发生率,并提供有效的短期疼痛缓解。这种方法对改善患者预后具有重要意义。
OBJECTIVE: The aim of this
study was to investigate whether multimodal analgesia can decrease postoperative opioid usage in patients undergoing shoulder arthroscopy.
METHODS: Patients diagnosed with subacromial impingement syndrome who underwent acromioplasty at our institution between October 2022 and November 2023 were retrospectively analyzed. Patients were divided into an observation group and a control group based on postoperative pain management methods. The control group received intravenous self-controlled electronic analgesia (sufentanil injection 1 μg/kg + butorphanol injection 4 mg + 0.9% NaCl injection to 100 mL), while the observation group received multimodal analgesia (ropivacaine subacromial pump 3 mL/h, combined with oral celecoxib and acetaminophen). Visual Analog Scale (VAS) scores were recorded preoperatively and at various postoperative time points, and opioid usage, length of hospital stay, and analgesia-related complications within 1 week postoperatively were compared between groups. The 36-item Short Form Health Survey (SF-36) scores and the Constant-Murley score (CMS), were also assessed 1 day and 1 week after treatment.
RESULTS: One hundred thirty-two patients were included in the
study, 66 in the observation group and 66 in the control group. In the control group, there were 46 males and 20 females, with a mean age of 55.47 ± 11.42 years and in the observation group 44 males and 22 females, with a mean age of 56.13 ± 12.19 years The observation group consistently reported significantly lower pain intensity compared to the control group at 8 h (T1), 24 (T2), and 48 h (T3) after surgery (p < 0.05). Additionally, the observation group exhibited significantly lower opioid usage and complication rates compared to the control group (p < 0.05). SF-36 scores and CMS scores were significantly higher in the observation group 1 week after treatment compared to the control group (p < 0.05).
CONCLUSIONS: Following shoulder arthroscopy, multimodal analgesia effectively reduces opioid consumption, lowers complication rates, and provides effective short-term pain relief. This approach carries significant implications for improving patient outcomes.