罗哌卡因局部浸润用于显微内镜腰椎间盘切除术后镇痛

Effect of local tissue infiltration with ropivacaine on pain after micro-endoscopic lumbar discectomy

目的:评价罗哌卡因切口周围局部浸润在显微内镜腰椎间盘髓核摘除术后镇痛中的作用。方法:83例行显微内镜腰椎间盘髓核摘除术患者随机分成2组,A组(n=43)手术开始前以0.75%盐酸罗哌卡因10mL于切口周围肌层和皮下局部浸润;B组(n=40)手术开始前以0.9%生理盐水10mL于切口周围肌层和皮下局部浸润。对手术后患者的疼痛指数、阿片类镇痛药物使用量以及切口愈合情况等进行统计观察。结果:A组患者的结果明显优于B组,A组患者术后疼痛反应轻、阿片类镇痛药物使用量少、胃肠道反应发生率低、住院时间更短。所有患者未出现切口愈合不良等并发症。结论:罗哌卡因切口周围局部浸润对于缓解显微内镜腰椎间盘髓核摘除术后疼痛具有优良的效果,能明显缩短患者术后恢复的时间,值得临床推广使用。

OBJECtIVE To investigate the preemptive analgesic effect of ropivacaine infiltration at incision in micro-endo- scopic lumbar discectomy. METHODS 83 eases of micro-endoscopic lumbar discectomy were randomly allocated to 2 groups as follows： Group A（n = 43） had 10 mL 0. 75% ropivacaine injected into the paravertebral muscles and subcutaneous tissues just before wound incision; Group B （n = 40） received 10 mL 0. 9% saline at these sites. Vital signs, postoperative pain scores, wound healing and opioid drug usage were recorded. RESULTS Group A treated with ropivacaine （by preincision wound infil- tration） showed significantly better results than group B for most parameters. Patients in group A practiced less pain experi- ence, had lower opioid requirements after surgery, lower incidences of nausea, and shorter hospital stays. None of patients of two groups developed delayed wound healing and other complications after mirco-endoscopic lumbar discectomy. CONCLUSION Preineision wound infiltration with ropivacaine is an effective management in pain relieving after mirco-endoscopic lumbar dis- cectomy and is recommended for clinical use.