腰椎后路椎间盘镜微创术围手术期多模式镇痛的临床观察

Multiple-model Pain Control Methods for Perioperative Pain Relief Around Lumar Discectomy with Microendoscopy

目的观察舒芬太尼、氟比洛芬酯联合局部浸润麻醉在腰椎后路椎间盘镜围手术期的镇痛效果及不良反应。方法择期行腰椎后路椎间盘镜手术治疗的患者60例,ASAⅠ~Ⅱ级,随机分为2组,对照组（C组,n=30）和多模式镇痛组（M组,n=30）。手术开始前由术者对两组患者切口行局部浸润麻醉,显露神经根后用1ml利多卡因原液神经阻滞。M组在切皮前15min静脉注射氟比洛芬酯1mg/kg和舒芬太尼0.015μg/kg,C组不给药。记录围手术期各时间点的镇痛评分（VAS）、术后镇痛药使用情况及不良反应发生情况。结果两组患者的一般情况、手术时间及局麻药用量无明显差异;手术开窗、探查神经根、神经根松解、术后1、4、6hVAS评分M组均低于C组,两组比较差异有统计学意义（P〈0.05）,围术期曲马多的用量M组（50.6±20.1）mg低于C组（165.5±46.3）mg（P〈0.05）,所有患者均无呼吸抑制、瘙痒,恶心呕吐等严重并发症,两组不良反应差异无显著意义（P〉0.05）。结论舒芬太尼、氟比洛芬酯联合局部浸润麻醉的多模式镇痛可为腰椎后路椎间盘镜围手术期提供良好的镇痛,不良反应发生率低且有利于术后恢复。

Objective To investigate the patients＇ multimodal analgesia effect and related adverse events around lumar discectomy with microendoscopy.Methods Sixty patients of lumbar disc herniation,ASAⅠand Ⅱ,undergoing microendoscopic discectomy were randomly allocated into 2 groups： control group（Group C,n=30）and multimodal group（Group M,n=30）.Local anesthesia at the surgical site wag facilitated by the surgeon before the beginning of surgery.In Group M,Flurbiprofen 1mg/kg and sufentanyl 0.015μg / kg were administered intravenously 15min preincision.Access the pain scale around microendoscopic dissectomy,record the doses of tramal and the incidence of adverse effects.Results The age,body weight,sex,operation times and total doses of local anesthesia were no significant difference between two groups.The VAS of group M was lower than that of group C（P0.05）.The total doses of tramal of group M and C were（50.6±20.1）mg and（165.5±46.3）mg respectively,and there was significant difference between two groups.The side effects such as vomit and nausea were same between group M and C（P0.05）.Conclusion Multimodal analgesic regimen of infiltration of local anesthetic at surgical site and intravenous flurbiprofen and sufentanyl provide sufficient analgesia,lower pain scores,minimizes the related adverse events and ensures the safety around lumar discectomy with microendoscopy.