围手术期不同镇痛方案对肩关节镜下肩袖修复 术后疼痛和康复的影响.

OBJECTIVE: To probe into the effects of different perioperative analgesic regimens on pain degree and rehabilitation efficacy after arthroscopic rotator cuff repair, so as to provide references for optimizing individualized analgesic regimen, promoting early rehabilitation of rotator cuff injury and improving shoulder joint function. METHODS: A total of 150 patients with rotator cuff injury admitted into the hospital from May 2020 to May 2022 were extracted to be divided into three groups via random number table method, with 50 cases in each group. Patients in group A was given ropivacaine injection during surgery, patients in group B was given ropivacaine injection during surgery and oral celecoxib after surgery, patients in group C was given ropivacaine injection during surgery and oral celecoxib during perioperative period. The postoperative rehabilitation, visual analogue scale (VAS) scores at different time points after surgery, inflammatory indicators [interleukin 6 (IL-6), interleukin 10 (IL-10) and prostaglandin E2 (PGE2)], functional rehabilitation [ University of California at Los Angeles ( UCLA) shoulder joint score and American Society for Shoulder and Elbow Surgery (AESE) score], adverse drug reactions of analgesic drugs, rotator cuff recovery at 3 months after surgery were compared among three groups. RESULTS: The hospital stays of group B and group C were respectively (2. 57±0. 56) d and (2. 74±0. 41) d, shorter than (3. 56±0. 34) d of group A; the hospitalization costs of group B and group C were respectively (27. 1±5. 2) thousand yuan and (26. 9±6. 3) thousand yuan, both were shorter than (31. 2±4. 8) thousand yuan of group A; the incidences of system inflammatory reaction syndrome (SIRS) of group B and group C were respectively 14% (7 / 50) and 6% (3 / 50), both were lower than 36% (18 / 50) of group A; at 3 days after surgery, the VAS score of group B and group C was lower than that of group A, all the above differences were statistically significant (P<0. 05). There were no statistical significance in differences in postoperative hospital stay, hospitalization cost, incidence of SIRS, VAS score at 3 days after surgery between group B and group C (P>0. 05). In the comparisons of VAS scores at 7 days, 14 days and 1 month after surgery, group C < group B < group A, with statistically significant differences (P<0. 05). At 7 days, 14 days and 1 month after surgery, the serum IL-6 and PGE2 levels of the three groups decreased, the IL-10 levels increased; in the comparison of serum IL-6 and PGE2 levels, group C < group B < group A, and in the comparison of serum IL-10 levels, group C > group B > group A, with statistically significant differences (P<0. 05). At 14 days, 1 month and 3 months after surgery, the UCLA and ASES scores of the three groups increased, and group C > group B > group A, with statistically significant differences (P<0. 05). The incidences of adverse analgesic drug reactions of group B and group C were respectively 12% (6 / 50) and 18% (9 / 50), the differences were not statistically significant (P > 0. 05). The healing rates of rotator cuff in group A, group B, and group C were respectively 86% (43 / 50), 90% (45 / 50) and 88% (44 / 50), the incidences of re-tear were respectively 14% (7/ 50), 10% (5/ 50) and 8% (4/ 50) in group A, group B and group C, the differences were not statistically significant (P>0. 05). CONCLUSIONS: The analgesia after arthroscopic rotator cuff repair is contributes to shortening hospital stay, accelerating rehabilitation process, relieving postoperative pain, controlling inflammatory reaction caused by stress and improving shoulder joint function, and intraoperative injection of ropivacaine combined with perioperative oral celecoxib is superior in analgesia, anti-inflammation and rehabilitation. [ABSTRACT FROM AUTHOR]