围术期多模式镇痛在腰椎后路内固定融合术中的应用

Clinical efficacy of perioperative multimodal analgesia in patients after posterior lumbar fusion with internal fixation

目的探讨围术期多模式镇痛方案在腰椎后路内固定融合手术患者中的应用效果。方法前瞻性研究2011年7月至2012年12月于本院行腰椎后路内固定融合手术患者共64例,根据镇痛方案不同随机分为多模式镇痛组(M组,32例)和单一方法镇痛组(S组,32例)。多模式镇痛组联合采用口服塞来昔布超前镇痛、术中局部浸润麻醉、术毕留置静脉自控镇痛泵(patient controlled analgesia,PCA)、术后静脉注射帕瑞昔布方法;单一方法镇痛组仅留置PCA。记录两组术后3、12、24、48 h及首次下床活动时疼痛视觉模拟评分(visual analogue scale,VAS);记录总体镇痛满意度、PCA按压次数与用药量、补救镇痛情况;观察镇痛相关不良反应及术后引流情况。结果患者均顺利完成手术。M组术后3、12、24、48 h及首次下床活动的VAS评分均低于S组(P<0.05),总体镇痛满意度优于S组;M组PCA按压次数、芬太尼用量低于S组(P<0.05);不良反应发生率M组低于S组(P<0.05)。两组术后伤口引流量差异无统计学意义(P>0.05)。两组均无严重并发症发生。结论应用多模式镇痛可有效缓解腰椎后路内固定融合手术患者的疼痛,减少阿片类药物用量,降低副作用,是一种安全、有效的镇痛方法。

Objective To determine the clinical efficacy of perioperative multimodal analgesia in the patients undergoing posterior lumbar fusion surgery with internal instrumentation. Methods From July 2011 to December 2012, 64 patients scheduled for posterior lumbar fusion surgery with internal instrumentation were prospectively recruited in the study, and randomly divided into 2 groups, multimodal analgesia group （group M, n=32） and single intravenous patient controlled analgesia （PCA） group （group S, n=32）. The multimodal analgesia regimen included preoperative celecoxib, local infiltration analgesia with ropivacaine, PCA and postoperative parecoxib. Visual analogue scale （VAS） scores at rest were recorded in 3, 12, 24, and 48 h postoperatively. Patient pain levels during the first ambulation and discharge were also documented. The number of PCA attempts, drug dosage in PCA, satisfaction rate, requirement for rescue analgesic and adverse events were also recorded. Results Compared with group S, the VAS scores were significantly decreased at 3, 12, 24 and 48 h after surgery and at the first ambulation, and the satisfaction rate was increased in group M （P〈0.05）. The number of PCA attempts, drug dosage in PCA and incidences of adverse effects were obviously lower in group M than in group S （P〈0.05）. There was no significant difference in the amount of drainage between the 2 groups （P〉0.05）. No serious postoperative complication occurred in either group. Conclusion Multimodal analgesia is a safe and effective analgesic regimen for the patients undergoing posterior lumbar fusion surgery with internal instrumentation. Patients demonstrate better pain scores and lower opioids requirements.