颈椎后路单开门椎管扩大减压术中局部复合浸润镇痛方案的安全性和有效性:一项前瞻性随机对照研究

Safety and efficacy of local infiltration analgesia in posterior single-door laminoplasty and decompression in cervical spine: A prospective randomized controlled study

背景:加速康复外科理念已在骨科广为应用,减少手术创伤和术后疼痛有利于患者更快更好地恢复。目的:探讨颈椎后路单开门椎管扩大减压手术中使用局部复合浸润镇痛方案("鸡尾酒"镇痛)的安全性和有效性。方法:前瞻性纳入2019年1月至2020年10月行颈椎后路单开门减压手术患者168例,根据术中是否给予"鸡尾酒"镇痛,随机分为研究组和对照组,每组84例。局部用药配方为:盐酸罗哌卡因200 mg、枸橼酸芬太尼注射液100μg、氟比洛芬酯注射液50 mg、氨甲环酸1 g,生理盐水配至60 ml行术区多点浸润镇痛。主要评价指标为术后各时间点视觉模拟疼痛评分(visual analogue scale,VAS)、术后引流量、血红蛋白下降值、镇痛泵使用次数及补救镇痛率、恶心呕吐发生率、切口并发症及术后住院时间。结果:研究组VAS评分在术后即刻、第2天下地及第3天活动时显著低于对照组(P<0.05),而两组术后第1天静息状态、术后3个月VAS评分无统计学差异(P>0.05)。研究组镇痛泵按压次数、补救镇痛率、恶心呕吐发生率、总引流量和血红蛋白下降值均低于对照组(P<0.05)。两组均无输血及深部感染,术后3个月JOA评分无统计学差异(P>0.05)。结论:颈椎后路单开门手术中应用局部复合浸润镇痛方案,具有术后疼痛程度轻、阿片类镇痛药物用量少、恶心呕吐发生率低等特点,符合加速康复外科的理念,有助于患者早期康复。

Background:The concept of enhanced recovery after surgery(ERAS)has been widely used in orthopaedics.Reducing surgical trauma and postoperative pain can be helpful to patients for better recovery.Objective:To investigate the safety and efficacy of local infiltration analgesia("cocktail"analgesia)in cervical posterior single-door laminoplasty and decompression.Methods:From January 2019 to October 2020,patients who underwent posterior single-door laminoplasty were prospectively included and randomly divided into study group and control group(n=84).The analgesic formulas were as follows:ropivacaine hydrochloride 200 mg,fentanyl citrate 100μg,flurbiprofen axetil 50 mg,tranexamic acid 1 g,with normal saline to 60ml for multi-point infiltration analgesia.Visual analogue scale(VAS),postoperative drainage,hemoglobin drop,analgesic pump use times and remedial analgesia rate,nausea and vomiting rate,incision complications and postoperative hospitalization time were evaluated.Results:The VAS score in the study group was significantly lower than that in the control group immediately after surgery,day 2 and 3 of physical activity(P<0.05),while there was no significant difference in the VAS score between the two groups in resting or 3 months after operation(P>0.05).The number of analgesic pump press,the utilization rate of analgesic drugs,the incidence of nausea and vomiting,total drainage and the decrease of hemoglobin in the study group were lower than those in the control group(P<0.05).No blood transfusion or deep infection occurred.There was no significant difference in JOA score between goups at 3 months after surgery.Conclusions:Local infiltration analgesia is effective in posterior cervical single-door laminoplsty.It can help to decrease postoperative pain,which also lead to less opioid analgesic use and low incidence of nausea and vomiting.This new methods can be an effective and safe measure in ERAS management.