The Effect Of Suprascapular Nerve Block With Axillary Nerve Block For Arthroscopic Rotator-cuff Repair Surgery

Objective:After shoulder arthroscopy,patients often experience considerable pain,and the choice of analgesia can provide good analgesia while minimizing complications.Currently commonly used analgesic methods include intravenous opioid analgesics,or interplanar brachial plexus block,but both have varying degrees of adverse effects.This study was designed to investigate whether ultrasound-guided superior scapular nerve sacral nerve block can provide satisfactory analgesia after shoulder arthroscopy and reduce the effects on the phrenic and distal muscles.METHODS: Sixty patients with general anesthesia and unilateral shoulder arthroscopy were enrolled,including 29 males and 31 females,aged 18-65 years,BMI 19.5-28.1kg/m2,ASAI-II,randomized.Divided into three groups of 20 cases each.The intravenous group(group I)did not require special treatment before surgery,and the opioid analgesic drug was administered intravenously before the end of the operation.Intramuscular groove brachial plexus block(group I)underwent ultrasound-guided0.25% ropivacaine 20 ml intermuscular sulcus brachial plexus block,suprascapular nerve combined sacral nerve block group(S group)under ultrasound guidance 0.25%ropivacaine 15 ml of the supraorbital nerve and 5ml of the phrenic nerve.Observe and record the VAS score,the total amount of analgesic drugs and the incidence of nausea and vomiting,and the distal limbs of the limbs at 2 hours,4 hours,6 hours after surgery,24 hours after surgery,and 24 hours after surgery.Force condition,degree of numbness of the distal limbs,degree of sedation;observation of the amplitude of the diaphragmatic muscles under the deep breathing of the patients before and after leaving the PACU;the satisfaction of analgesia at the time of hospitalization.RESULTS: There was no significant difference in the mean VAS scores between the two groups at 2h,4h,6h,and 24 h after surgery.After 24 h,the intermuscular groove group could provide longer analgesia.The intermuscular groove group was more prone to obvious numbness.Twelve of the 20 patients had strong numbness on the surgical side when they left the PACU,lasting about 12 hours,and the same situation occurred in 3cases in the composite nerve group.In the intermuscular sulcus block,the muscle strength of the operation side was significantly attenuated.The muscle strength of the patient was about 50% at 6h after surgery and 80% before surgery at 24 h.The effect of the composite nerve block on muscle strength was Not so strong,the patient’s muscle strength can be restored to 70% before surgery at 6h.There were no significant differences in postoperative nausea and vomiting and sedation scores.Two groups of patients had nausea in 2 and 1 patients,and there was no significant difference in the amount of opioids between the two groups.Intermuscular sulcus block has a significant blockade on the movement of the diaphragm.When the patient leaves the PACU,the amplitude of the movement of the diaphragmatic muscle and the deep breath are 63%and 42%,respectively.The composite nerve group was reduced by 37% and 29%,respectively.The composite nerve group had little effect on the diaphragmatic movement of the patient,so it had little effect on the patient’s respiratory function.Conclusion: The intermuscular sulcus block can provide comprehensive analgesia,but the side effects of numbness and muscle strength are more obvious.The composite nerve block group had little effect on muscle strength and diaphragm,and there was no significant difference in analgesia.