布比卡因脂质体行肌间沟臂丛神经阻滞对全身麻醉肩关节镜患者术后镇痛及早期功能恢复的影响

Effects of interscalene brachial plexus block with liposomal bupivacaine on postoperative analgesia and early functional recovery in patients undergoing shoulder arthroscopy under general anesthesia

摘要:

目的 探讨布比卡因脂质体用于肌间沟臂丛神经阻滞对全身麻醉肩关节镜患者术后镇痛及早期功能恢复的影响。方法 选取2024年6月—2025年4月徐州医科大学附属淮安医院收治的96例全身麻醉肩关节镜手术患者，按随机数字表法分为对照组（盐酸罗哌卡因）和观察组（布比卡因脂质体），各48例。比较两组患者手术指标、血流动力学、疼痛指标、早期恢复指标、炎症指标、应激指标及不良反应的发生情况。结果 观察组与对照组手术时间和住院时间比较，差异均无统计学意义（P >0.05）。观察组与对照组入手术室时、术毕、术后30 min的心率（HR）、平均动脉压（MAP）比较，结果 ①不同时间点HR、MAP比较，差异均有统计学意义（P <0.05）；②观察组与对照组HR、MAP比较，差异均有统计学意义（P <0.05），观察组HR较低，MAP较高；③两组HR、MAP变化趋势比较，差异均有统计学意义（P <0.05）。观察组与对照组术后1、6、12和48 h的静息状态下视觉模拟评分法（VAS）评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P <0.05），观察组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组术前后恢复质量量表评分、前屈活动度、外展活动度的差值均大于对照组（P <0.05）。观察组术前后白细胞介素-6、C-反应蛋白、丙二醛、超氧化物歧化酶的差值均小于对照组（P <0.05）。观察组与对照组不良事件总发生率比较，差异无统计学意义（P >0.05）。结论 布比卡因脂质体肌间沟臂丛神经阻滞可显著改善全身麻醉肩关节镜患者的术后镇痛效果，促进早期功能恢复，减轻炎症反应，且安全性良好，具有临床推广价值。

Abstract:

Objective To investigate the effects of interscalene brachial plexus block with liposomal bupivacaine on postoperative analgesia and early functional recovery in patients undergoing shoulder arthroscopy under general anesthesia.Methods A total of 96 patients scheduled for shoulder arthroscopy under general anesthesia at The Affiliated Huai'an Hospital of Xuzhou Medical University from June 2024 to April 2025 were selected. They were divided into a control group (n = 48, ropivacaine hydrochloride) and an observation group (n = 48, liposomal bupivacaine). Surgical parameters, hemodynamics, pain scores, early recovery indicators, inflammatory markers, stress responses, and adverse events were compared between groups.Results No significant differences were observed in operative duration or length of hospital stay between the two groups (P > 0.05). The HR and MAP were compared between the observation and control groups at entry to the operating room, end of surgery, and 30 minutes postoperatively. The results revealed that significant differences in HR and MAP were observed across the different time points (P < 0.05) and between the observation and control groups at each time point (P < 0.05), with lower HR and higher MAP in the observation group. The change trends of HR and MAP over time differed significantly between the two groups (P < 0.05). Visual Analog Scale (VAS) scores at rest in the two groups were compared at 1, 6, 12, and 48 hours postoperatively, which demonstrated that they were different across time points (P < 0.05) and between the groups (P < 0.05), with lower VAS scores in the observation group, indicating superior analgesic efficacy. The change trends of VAS scores over time also differed significantly between the groups (P < 0.05). The differences in pre- and postoperative QoR-15 scores, forward flexion range of motion, and abduction range of motion were greater in the observation group than in the control group (P < 0.05). Conversely, the changes in IL-6, CRP, MDA, and SOD levels were smaller in the observation group compared with the control group (P < 0.05). No significant differences were observed in the overall incidence of adverse events between the two groups (P > 0.05).Conclusion Interscalene brachial plexus block with liposomal bupivacaine enhances postoperative analgesia, promotes early functional recovery, and reduces inflammatory responses in patients undergoing shoulder arthroscopy under general anesthesia without compromising safety, demonstrating significant clinical value.