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Hemidiaphragmatic paralysis following ultrasound-guided anterior vs. posterior suprascapular nerve block: a double-blind, randomised control trial
肌间沟臂丛神经阻滞为肩部手术患者提供了良好的镇痛效果，但与膈肌麻痹有关。在考虑联合应用肩胛上神经和腋神经阻滞以替代肌间沟臂丛神经阻滞之前，根据肩胛上神经阻滞入路评估膈肌功能障碍的发生率是非常有必要的。
将84例接受肩关节镜手术的患者随机分配到前路肩胛上神经阻滞联合腋神经阻滞组或后路肩胛上神经阻滞联合腋神经阻滞组，各神经均使用0.375%罗哌卡因10ml进行阻滞。主要观察指标是超声诊断下膈肌麻痹的发生率。次要观察指标包括随着时间推移膈肌麻痹的特征、疼痛评分、口服消耗吗啡当量及患者满意度。
前、后路肩胛上神经阻滞膈肌麻痹的发生率分别为40%（n=17）和2%（n=1）（p < 0.001）。三分之一膈肌麻痹患者持续时间超过8h。无论在恢复区(20 [5-31(0-60)] mg vs.7.5[0-14(0-52)] mg；p = 0.004)还是术后前24h (82 [61-127 (12-360) mg] vs. 58 [30-86(0-160)] mg；p = 0.01)，后路肩胛上神经阻滞组口服吗啡当量的中位数(四分位间距[间距])均明显高于前路组。患者满意度组间无明显差异(p=0.6)。
与前路相比，后路肩胛上神经阻滞能较好地保留膈肌功能。
原始文献摘要
Ferré F, Pommier M, Laumonerie P, et al. Hemidiaphragmatic paralysis following ultrasound-guided anterior vs. posterior suprascapular nerve block: a double-blind, randomised control trial[J] .Anaesthesia, 2020, 75: 499-508.
Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the suprascapular nerve block combined with an axillary nerve block using 10 ml ropivacaine 0.375% for each nerve. The primary outcome was the incidence of hemidiaphragmatic paralysis diagnosed by ultrasound. Secondary outcomes included: characterisation of the hemidiaphragmatic paralysis over time; numeric rating scale pain scores; oral morphine equivalent consumption; and patient satisfaction. The incidence of hemidiaphragmatic paralysis was 40% (n = 17) vs. 2% (n = 1) in the anterior and posterior groups, respectively (p < 0.001). In one third of patients with hemidiaphragmatic paralysis, it persisted beyond the eighth hour. The median (interquartile range [range]) oral morphine equivalent consumption was significantly higher in the posterior approach when compared with the anterior approach, whether in the recovery area (20 [5–31 (0–60)] mg vs. 7.5 [0–14 (0–52)] mg, respectively;p = 0.004) or during the first 24 h (82 [61–127 (12–360) mg] vs. 58 [30–86 (0–160)] mg, respectively; p = 0.01). Patient satisfaction was comparable between groups (p = 0.6). Compared with the anterior approach, diaphragmatic function is best preserved with the posterior needle approach to the suprascapular nerve block.
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贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：冯玉蓉 审校：王贵龙
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