超声引导下肩关节囊周神经阻滞与肌间沟臂丛神经阻滞在肩关节镜术后恢复效果的比较

Effects of ultrasound-guided pericapsular nerve group block versus interscalene brachial plexus block on postoperative recovery after shoulder arthroscopy

摘要:

目的 探讨超声引导下肩关节囊周神经阻滞（PENG）与肌间沟臂丛神经阻滞（ISB）在肩关节镜术后恢复的效果。方法 采用非劣效性研究设计，选取2023年1月—2024年6月于嘉兴市第二医院行单侧肩关节镜下肩袖修补手术的190例患者，按照区组随机化的方法随机分为PENG组、ISB组，各95例。术后PENG组失访6例，ISB组失访4例，最终研究纳入PENG组89例、ISB组91例。比较两组术后恢复质量评定量表（QoR-40）评分、疼痛数字评分量表（NRS）评分、第1次镇痛补救时间、镇痛补救率、术后镇痛泵按压次数、麻醉剂用量及不良反应。结果 PENG组治疗前与术后24 h QoR-40评分的差值小于ISB组（P <0.05）。PENG组与ISB组术后30 min和4、8、12、24、48 h静息状态NRS评分比较，结果 ①不同时间点NRS评分比较，差异有统计学意义（P <0.05）；②PENG组与ISB组NRS评分比较，差异有统计学意义（P <0.05），PENG组NRS评分更低；③两组NRS评分变化趋势比较，差异有统计学意义（P <0.05）。PENG组补救镇痛率低于ISB组（P <0.05），镇痛泵按压次数少于ISB组（P <0.05）。PENG组术后反跳痛发生率低于ISB组（P <0.05）。结论 超声引导下肩关节PENG在肩关节镜术后的恢复效果与ISB相当；PENG对RCI患者可实现有效镇痛，且安全性良好。

Abstract:

Objective To investigate the effects of ultrasound-guided pericapsular nerve group (PENG) block versus interscalene brachial plexus (ISB) block on postoperative recovery after shoulder arthroscopy.Methods This non-inferiority study enrolled 190 patients undergoing unilateral arthroscopic rotator cuff repair at Jiaxing Second Hospital between January 2023 and June 2024. They were randomly assigned to either the PENG group or the ISB group (95 patients each) using block randomization. Postoperatively, 6 patients were lost to follow-up in the PENG group and 4 in the ISB group, resulting in 89 patients in the PENG group and 91 in the ISB group for final analysis. The two groups were compared in terms of the postoperative Quality of Recovery-40 (QoR-40) scores, Numerical Rating Scale (NRS) scores, time to first rescue analgesia, the rescue analgesia rate, number of postoperative patient-controlled analgesia pump presses, anesthetic consumption, and adverse reactions.Results The difference in QoR-40 scores before treatment and 24 hours after surgery was smaller in the PENG group compared to the ISB group (P < 0.05). A comparison of resting NRS scores between the PENG and ISB groups at 30 minutes and 4, 8, 12, 24, and 48 hours after surgery demonstrated that they were different across the time points (P < 0.05) and between the groups (P < 0.05), with lower NRS scores in the PENG group. The change trend of NRS scores between the two groups was statistically significant (P < 0.05). The rate of rescue analgesia in the PENG group was lower than that in the ISB group (P < 0.05), and the number of patient-controlled analgesia pump presses was lower in the PENG group (P < 0.05). The incidence of rebound pain after surgery was lower in the PENG group than in the ISB group (P < 0.05).Conclusion Ultrasound-guided PENG block provides postoperative recovery comparable to ISB block after shoulder arthroscopy. It achieves effective analgesia in patients with rotator cuff injury and demonstrates a favorable safety profile.