Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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10.18869/acadpub.tumj
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بررسی اثر تزریق موضعی بوپیواکایین و تریامسینولون بر درد شانه و دامنه حرکتی مفصل شانه به دنبال حوادث مغزی
Evaluating the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and restricted range of motion following cerebrovascular accidents
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<p dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify" class="MsoNormal"><strong><span style="font-size: 10pt">زمینه و هدف</span></strong><span style="font-size: 10pt">:</span><span style="font-size: 10pt"> </span><span style="font-size: 10pt">درد شانه از شایعترین
و با اهمیتترین عوارض حوادث مغزی میباشد. این مطالعه با هدف تعیین اثر تزریق
موضعی بوپیواکایین وتریامسینولون بر درد شانه و دامنه حرکتی مفصل شانه به دنبال
حوادث مغزی انجام شد. </span><strong><em><span style="font-size: 10pt"><br></span></em></strong></p><p dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify" class="MsoNormal"><strong><span style="font-size: 10pt">روش بررسی:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">این
مطالعه بهصورت کارآزمایی بالینی یک سوکور انجام شد. از 70 بیمار مبتلا به درد
مزمن شانه 35 نفر مبتلا به حادثه مغزی در گروه مورد و 35 نفر بدون ابتلا به حادثه
مغزی در گروه شاهد قرار گرفتند. در دو گروه با تکنیک </span><span style="font-size: 7pt">D</span><span style="font-size: 8pt">angoisse</span><span style="font-size: 10pt"> و همکارانش
بلوک عصبی سوپرااسکاپولار و تزریق بورس سابآکرومیال با بوپیواکایین وتریامسینولون
انجام شد. بیماران در هفته اول، هفته ششم و هفته دوازدهم پس از تزریق پیگیری شدند
و درد شانه و دامنه حرکتی مفصل شانه در این بیماران اندازهگیری شد. <br></span></p><p dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify" class="MsoNormal"><span style="font-size: 10pt"></span><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">میانگین سن افراد مورد بررسی 07/9</span><span style="font-size: 8pt">±</span><span style="font-size: 10pt">9/60 سال بود. بهبود شدت درد
دوازده هفته پس از بلوک عصب سوپرااسکاپولار و تزریق بورسای سابآکرومیال با بوپیواکایین
وتریامسینولون در بیماران بدون ابتلا به حادثه مغزی بهطور معنیداری بیشتر بود (001/0</span><span style="font-size: 7pt">=</span><span style="font-size: 7pt">P</span><span style="font-size: 10pt">). همچنین بهبود دامنه حرکتی مفصل شانه </span><span style="font-size: 8pt">(</span><span style="font-size: 7pt">B</span><span style="font-size: 8pt">ackward extension</span><span style="font-size: 8pt">)</span><span style="font-size: 10pt"> پس از بلوک عصب
سوپرااسکاپولار و تزریق بورس سابآکرومیال با بوپیواکایین وتریامسینولون در
بیماران بدون ابتلا به حادثه مغزی بهطور معنیداری بیشتر بود (001/0</span><span style="font-size: 7pt">=</span><span style="font-size: 7pt">P</span><span style="font-size: 10pt">). <br></span></p><p dir="rtl" style="direction: rtl unicode-bidi: embed text-align: justify" class="MsoNormal"><span style="font-size: 10pt"></span><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">در
بیماران بدون ابتلا به حادثه مغزی بلوک عصب سوپرااسکاپولار و تزریق بورس سابآکرومیال
با بوپیواکایین وتریامسینولون در کاهش درد شانه و بهبود دامنه حرکتی مفصل شانه </span><span style="font-size: 8pt">(</span><span style="font-size: 7pt">B</span><span style="font-size: 8pt">ackward extension</span><span style="font-size: 8pt">)</span><span style="font-size: 10pt"> درمانی موثر و ایمن
است در حالیکه در بیمارانی که دچار حادثه مغزی شدهاند، درمان موثری نیست.<span> </span></span></p>
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<!--stripped--> <strong>Background</strong><strong>:</strong> Shoulder pain is a common complication of cerebrovascular accidents. This study was conducted to assess the effects
of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain
and on restricted range of motion following brain events. <br><strong>Methods</strong><strong>:</strong> This single-blind clinical trial study included 35 patients
with chronic shoulder pain (the controls) and 35 patients
with chronic shoulder pain due to brain events (the case group). The study was
done at Imam Hossein Hospital & Gandhi Day Clinic
during the year 2008-2010. The patients in the
two groups received bupivacaine and triamcinolone acetate for subacromial bursa
injection and suprascapular nerve block by following the protocol described by
Dangoisse et al. The patients were followed up for 12
weeks and they were evaluated for pain and range of motion 1,
6, and 12 weeks after the
injections.<br><strong>Results</strong><strong>:</strong> The mean age of the patients was 60.9±9.07
years. Statistically significant improvements in pain score (P=0.001)
and shoulder joint range of motion (P=0.001)
were observed in patients with chronic shoulder pain versus patients with brain
events 12 weeks after
suprascapulare nerve block and subacromial bours injections by bupivacaine and triamcinolone acetate.<br><strong>Conclusion:</strong> Suprascapular
nerve block and subacromial bursa injections of bupivacaine and triamcinolone
acetate is a safe and efficacious treatment for the treatment of chronic shoulder
pain and restricted range of motion but it is not efficacious or of significant
value for the treatment of shoulder pain in patients with brain events.</p>
درد شانه،حوادث مغزی،دامنه حرکتی،مفصل شانه
Bupivacaine,cerebrovascular accident,joint,range of motion,shoulder pain,triamcinolone
381
387
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-225&slc_lang=fa&sid=1
Saadat Niaki
A
اسداله
سعادت نیاکی