布比卡因脂质体行肌间沟臂丛神经阻滞用于关节镜下肩袖修补术的效果观察

Effects of liposomal bupivacaine for interscalene brachial plexus block in arthroscopic rotator cuff repair

摘要:

目的 观察布比卡因脂质体行肌间沟臂丛神经阻滞用于关节镜下肩袖修补术的效果，为临床麻醉方案选择提供参考。方法 选取2024年9月—2026年1月在常州市武进中医医院拟行关节镜下肩袖修补术患者100例，采用随机数字表法将患者分为观察组、对照组，各50例。两组均行超声引导下肌间沟臂丛神经阻滞，观察组注入0.665%布比卡因脂质体20 mL，对照组注入0.375%罗哌卡因20 mL。比较两组患者麻醉相关指标、术后视觉模拟评分法（VAS）评分、肩关节功能指标、麻醉满意度及不良反应。结果 观察组镇痛持续时间长于对照组，首次补救时间晚于对照组，补救镇痛药用量、患者自控静脉镇痛（PCIA）实际按压次数、有效按压比均少于对照组（P <0.05）。观察组与对照组术后2、6、12、24、48、72 h的静息及运动状态下VAS评分比较，结果 ①不同时间点VAS评分比较，差异均有统计学意义（P <0.05）；②两组静息及运动状态下VAS评分比较，差异均有统计学意义（P <0.05），观察组VAS评分较低，相对镇痛效果较好；③两组静息及运动状态下VAS评分变化趋势比较，差异均有统计学意义（P <0.05）。观察组术后72 h肩关节活动度、康复锻炼依从性优于对照组（P <0.05）。观察组患者麻醉满意度高于对照组（P <0.05）。观察组患者不良反应总发生率低于对照组（P <0.05）。结论 布比卡因脂质体用于肌间沟臂丛神经阻滞在关节镜下肩袖修补术中可延长镇痛时间，减少阿片类药物用量与PCIA按压频次，优化早期肩关节功能康复，提高患者满意度，安全性更优。

Abstract:

Objective To evaluate the effects of liposomal bupivacaine for interscalene brachial plexus block in arthroscopic rotator cuff repair and provide a reference for selecting a clinical anesthesia regimen.Methods A total of 100 patients scheduled for arthroscopic rotator cuff repair at Wujin Hospital of Traditional Chinese Medicine between September 2024 and January 2026 were randomly divided into an observation group and a control group, with 50 patients in each group. Both groups underwent ultrasound-guided interscalene brachial plexus block. The observation group received 20 mL of 0.665% liposomal bupivacaine, whereas the control group received 20 mL of 0.375% ropivacaine. Anesthesia-related indicators, postoperative visual analog scale (VAS) scores, shoulder function, satisfaction with anesthesia, and adverse reactions were compared between the groups.Results The duration of analgesia was longer, the time to first rescue analgesia was later, and rescue analgesic consumption, the actual number of patient-controlled intravenous analgesia (PCIA) button presses, and the effective press ratio were lower in the observation group than in the control group (P < 0.05). Analysis of VAS scores at rest and during movement at 2, 6, 12, 24, 48, and 72 h postoperatively showed significant effects of time and group and a significant time-by-group interaction (P < 0.05); VAS scores were lower in the observation group. At 72 h postoperatively, shoulder range of motion and rehabilitation exercise compliance were better in the observation group than in the control group (P < 0.05). Satisfaction with anesthesia was higher and the overall incidence of adverse reactions was lower in the observation group than in the control group (P < 0.05).Conclusion Liposomal bupivacaine for interscalene brachial plexus block during arthroscopic rotator cuff repair prolongs analgesia, reduces opioid consumption and PCIA button presses, facilitates early shoulder rehabilitation, improves patient satisfaction, and has a favorable safety profile.