左旋布比卡因伤口局部持续输注用于脊柱手术后的镇痛效果

Efficacy of continuous wound infusion of levobupivacaine on postoperative pain relief after spinal surgery

目的观察伤口局部持续输注左旋布比卡因用于脊柱手术后的镇痛效果。方法择期行后路胸腰椎手术患者54例,随机分为两组:研究组采用局部镇痛泵经伤口持续输注0.25%左旋布比卡因,对照组使用静脉镇痛泵输注氟比洛芬酯、帕洛诺司琼、喷他佐辛,均在术后开启镇痛泵。采用疼痛VAS评分和Ramsay镇静评分评价术后2、4、6、12、24、36、48h疼痛及镇静程度,通过患者对镇痛系统是否满意、有无局部炎症、有无局部伤口渗液进行综合评价,并记录不良反应情况。结果术后48h内两组患者VAS评分和Ramsay镇静评分差异无统计学意义。研究组恶心呕吐、头晕发生率明显低于对照组(P<0.05)。结论伤口局部镇痛系统应用于脊柱手术后镇痛效果与静脉镇痛系统相似,但能降低不良反应的发生率。

Objective To observe the analgesic efficacy of continuous wound infusion of levobupivacaine after spinesurgery. Methods Fifty-four patients undergoing elective posterior thoracolumbar spine surgery were randomized into two equal groups： patients in experimental group were regional pumped with 0.25% levobupivacaine while patients in control group intravenously pumped with flurbiprofen axetil, palonosetron, and Pentazocine. Visual analogue scale（VAS）pain scales and Ramsay sedation scores were recorded at 2, 4, 6,12, 24, 36, and 48 h after operation. Patients＇ satisfaction, wound recovery （whether inflammation and exudation was exist）, and side effects were also recorded. Results There were no differences in VAS scores and Ramsay scores at postopreatively 2 to 48 hours between experimental group and control group. Otherwise, the incidence of nausea, vomiting, and dizziness was lower in experimental group compared with control group （P〈0.05）. Conclusion Local analgesia protocol applied for spine surgery is similar to intravenous analgesia regimen, whereas it is associated with a lower incidence of nausea, vomiting, and dizziness.