Objective To investigate the analgesia effects of ultrasound-guided suprascapular nerve blocks for shoulder arthroscopy without impacting respiratory function.Methods Forty seven patients scheduled for shoulder arthroscopy,17 males and 30 females,aged 26-78 years,weighing 50-75 kg,ASA physical status Ⅰ or Ⅱ,were randomized into suprascapular nerve blocks group (group S,n=24) and interscalene plexus blocks group (group Ⅰ,n =23).0.375％ ropivacaine 20 ml and 1 ％ lidocaine plus 1 ml of dexamethasone 5 mg.The vital capacity before and 6 h after surgery,extubation time,total PACU duration,VAS scores at awake time and 6 h,12 h,24 h after surgery,total opiods consumption,and other complications were recorded.Results The patients in group S exbuted significantly earlier than in group Ⅰ [(13.0±3.9) min vs (21.2±4.0) min,P＜0.05].The mean vital capacity 6 h after surgery significantly decreased in group Ⅰ [(2 909±502) ml vs (3 533±726) ml,P＜0.05].There were no significant differences of VAS scores or opiods consumption between the two groups.Conclusion Selective suprascapular nerve blocks can provide effective analgesia for shoulder arthroscopy without impacting the vital capacity.%目的 比较超声引导下前路肩胛上神经阻滞与肌间沟臂丛神经阻滞在肩关节镜手术中的镇痛效果及对肺活量的影响.方法 择期单侧肩关节镜手术患者47例,男17例,女30例,年龄26～78岁,体重50～75 kg,ASA Ⅰ或Ⅱ级.随机分为肩胛上神经阻滞组(S组,n=24)和肌间沟入路臂丛阻滞组(Ⅰ组,n=23).患者分别在全麻诱导前行超声引导下肩胛上神经阻滞(S组)及肌间沟入路臂丛神经阻滞(Ⅰ组),阻滞药物均为0.375％罗哌卡因20ml+地塞米松5 mg.记录患者术前及术后6h肺活量,拔管时间,PACU出室时间,术后苏醒即刻、6、12、24 h的静息VAS疼痛评分,术中及术后24 h内阿片类药物总量,记录不良反应情况.结果 S组患者术后拔管时间明显早于Ⅰ组[(13.0±3.9)min vs (21.2±4.0)min,P＜0.05].与术前比较,术后6hⅠ组肺活量明显下降[(2 909±502)ml vs(3 533±726)ml,P＜0.05],S组无明显变化[(3 620±808)ml vs(3 743±529)ml,P＜0.05],Ⅰ组明显低于S组(P＜0.05).两组患者术后VAS评分及阿片类总量差异无统计学意义.结论 超声引导下前路肩胛上神经阻滞可以为肩关节镜手术提供较为满意的镇痛,并对患者肺功能影响更小.
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