罗哌卡因在后路腰椎融合术多模式镇痛中的临床应用

Application of ropivacaine in multimodal analgesia for posterior lumbar fusion surgery

[目的]观察罗哌卡因切口周围浸润联合脊神经后支阻滞的多模式镇痛方案在后路腰椎融合术术后的镇痛效果及安全性。[方法]将2014年2月~2015年2月本院收治的60例后路腰椎融合患者随机分为两组,阻滞组30例,术中用罗哌卡因行切口周围浸润联合脊神经后支阻滞,对照组30例,不进行切口周围浸润或脊神经后支阻滞。分别观察各组术后6h、12h、24h、48h、72h休息及锻炼时视觉模拟评分(visual analogue score,VAS)、对疼痛超过4分的患者给予加用镇痛药物。比较两组的VAS评分,首次加用镇痛药物时间、使用量及副作用发生率,进行统计分析。[结果]两组患者在年龄、性别、体重指数、ASA分级、手术节段、主要病因方面差异无统计学意义,具有统计学可比性。在融合术后6h、12h、24h、48h休息及锻炼时,阻滞组视觉模拟评分均明显降低(P<0.05)。但在术后72h时两组视觉模拟评分差异无统计学意义。阻滞组术后首次使用镇痛药物时间比对照组明显延迟(P<0.05),同时使用量也明显降低(P<0.05)。[结论]罗哌卡因切口周围浸润联合脊神经后支阻滞的多模式镇痛方案可显著缓解后路腰椎融合术后48h内疼痛;减少吗啡用量,降低不良事件发生率,为腰椎后路融合术后早期镇痛提供了一种选择。

[Objective] To evaluate the efficacy and safety of infiltration of ropivacaine around the incision combined with block of dorsal rami of the spinal nerve in multimodal analgesia in posterior lumbar fusion surgery. [Methods ] A total of 60 patients admitted to our hospital from February 2014 to February 2015 received posterior lumbar fusion surgery. All patients were divided into treatment group treated with infiltration of ropivacaine around the incision combined with block of dorsal rami of the spinal nerve and control group without this treatment. The Visual Analogue Scale （VAS） scores at rest and exercises were recorded at 6, 12, 24, 48, and 72 hours post lumbar fusion surgery. If the score was higher than 4, additional analgesics would be given to the patients. The VAS score, time to first use of additional analgesics, analgesic dose, and incidence of ad- verse reactions were compared. [Results] There were no significant differences between the two groups in terms of age, sex, body mass index, American Society of Anesthesiologists （ASA） classification, operative level, and major cause. At 6, 12, 24, 48 hours after lumbar fusion surgery, the patients in treatment group had significant lower VAS scores at rest and exercises than those in the control group （P 〈0.05） . However, there was no significant difference between the two groups in VAS score at 72 hours after fusion. Moreover, the patients in treatment group had significantly delayed time for first use of additional analgesics and reduced dose of additional analgesics compared with the those in control group （P 〈0.05） . [Conclusions ] Infiltration of ropivacaine around the incision combined with block of dorsal rami of the spinal nerve in muhimodal analgesic regimen for posterior lumbar fusion surgery can significantly reduce the pain in 48 hours post the operation, reduce the dose of morphine and incidence of adverse reactions, therefore provide an alternative regimen for early analgesia after the operation.