腰椎后路融合术后多模式镇痛的安全性和疗效分析

Safety and Clinical Efficacy of Multimodal Analgesia on Postoperative Lumbar Posterior Fusion

目的评价多模式镇痛在腰椎后路融合术后的安全性及疗效。方法随机选择2014年6月—2016年12月在该院接受腰椎后路融合术治疗的患者180例,采用前瞻性研究,根据不同术后镇痛方案随机分为两组,命名为试验组(A组)和对照组(B组),每组90例,A组患者术后切口皮下注射罗哌卡因10 mL,术后连续3 d肌注帕瑞昔布钠40 mg/d,并使用患者自控镇痛泵(patient controlled analgesia,PCA),而B组中的患者术后使用患者自控镇痛泵(PCA),在手术后6、12、24、48 h分别各组的不良反应、不同状态下的VAS分值以及镇痛泵追加次数。结果试验组在术后各时段的平卧静止VAS分值分别为(3.3±1.2)分、(3.6±1.3)分、(4.0±0.6)分和(2.8±0.6)分,均低于对照组其VAS分值为(4.8±0.6)分、(5.2±1.6)分、(5.6±0.9)分和(4.9±0.6)分,主动活动的VAS疼痛评分分别为(6.4±1.8)分、(6.6±1.6)分、(6.1±2.3)分和(4.8±0.4)分,低于对照组的(7.8±0.3)分、(8.6±2.9)分、(8.2±1.9)分和(5.4±1.6)分,差异有统计学意义(P<0.05)。A组不良反应发生率和镇痛泵追加次数均少于B组(P<0.05)。结论多模式镇痛在腰椎后路融合术后应用安全有效,可减少阿片类药物的用量,降低不良反应发生率。

Objective This paper tries to evaluate the safety and efficacy of multimodal analgesia in lumbar posterior fusion. Methods 180 patients admitted and received lumbar posterior fusion surgery from June 2014 to December 2016 in this hospital were randomly selected and prospectively studied, and then these patients were randomly divided into the experimental group A and the control group B, with 90 cases in each group. Group A underwent subcutaneous injection of ropivacaine 10 mL, intramuscular injection of parecoxib sodium 40 mg per day for 3 days after operation, and patient controlled analgesia（PCA） was used, and group B used postoperative patient-controlled analgesia（PCA）, adverse events in each group at 6 h, 12 h, 24 h, 48 h after surgery were analyzed, VAS scores in different states and the number of analgesic pumps were collected. Results The mean VAS scores of the experimental group were（3.3±1.2）points,（3.6±1.3）points,（4.0±0.6）points and（2.8±0.6）points respectively, which were lower than those of the control group of（4.8±0.6）points,（5.2±1.6）points,（5.6±0.9）points and（4.9±0.6）points respectively. The VAS pain scores of the active excises were（6.4 ±1.8）points,（6.6 ±1.6）points,（6.1 ±2.3）points and（4.8 ±0.4）points, which were significantly lower than those of the control group of（7.8±0.3）points,（8.6±2.9）points,（8.2±1.9）points and（5.4±1.6）points and there was significant difference（P0.05）. The incidence of adverse reactions and the number of analgesic pumps in group A were less than those in group B（P0.05）. Conclusion Multidimensional analgesia on postoperative lumbar posterior fusion is more effective and safe; meanwhile it can reduce the consumption of opioids and the incidence of adverse reactions.