鏡視下腱板修復術における斜角筋ブロックの除痛効果に関する検討

抄録

Background: Shoulder surgery is often associated with severe postoperative pain. Purpose of this study was to evaluate the efficacy of pain reduction by using interscalene brachial plexus blocks with continuous versus single-shot for ARCR.
Methods: 32 shoulders which had undergone ARCR were the subjects of this study. They were assigned randomly into 3 groups, 11 cases were administered continuous interscalene brachial plexus block (0.25 ropivacaine, 4ml/hr) for 2 days postoperatively (Continuous Group “C”), 10 cases were administered single interscalene brachial plexus block with 10ml of 0.75% ropivacaine preoperatively (Single-Shot Group “SS”), and 11 cases without on interscalene brachial plexus block (Control Group “L”). The amount of diclofenac sodium applied, pentazocine injection used, and VAS were weighted as evaluation items between the groups. For VAS, measurement was applied soon after the operation, 1 and 6hours, 1, 2, 3, 7 and 14 days postoperatively. ANOVA was used for statistical examination, and the significance level being considered as under 5%.
Results: No significant difference in diclofenac sodium amounts applied, or pentazocine used was seen between the groups. For VAS, the significance was lower in SS and C than in L at 1 and 6 hours postoperatively (L:57mm, 58mm, 48m, SS:2.0mm, 2.0mm, 14mm, C:3.6mm, 9.1mm, 8.2mm). VAS had lower significance 1 day postoperatively in C (C 18mm, L 46mm, SS 54mm). No complications such as pneumothorax were found.
Conclusion: Both single-shot and continuous interscalene brachial plexus block for pain relief on the operation day were effective. The continuous interscalene brachial plexus block allows for continuous pain relief, and may reduce protective muscle contraction on shoulder muscles caused by postoperative pain.