局麻联合骶管麻醉在腰椎内窥镜手术中的镇痛效果

Analgesic effect of local anesthesia combined with sacral anesthesia in percutaneous endoscopic lumbar discectomy

[目的]探讨局部麻醉联合骶管麻醉在经皮腰椎内窥镜手术中的镇痛效果。[方法]2016年1月~2018年6月在本院因腰椎间盘突出症接受经皮内窥镜下腰椎间盘切除术治疗的50例患者纳入本研究,随机分为两组,每组25例。局麻组采用局部浸润麻醉;联合组为在局麻组的基础上术前10 min行骶管麻醉。记录导针刺破皮肤软组织扩开期(T1)、椎间孔成形期(T2)、纤维环及后纵韧带操作期(T3)、神经根松解髓核取出期(T4)各时段的视觉模拟评分(visual analogue scale,VAS)及平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)的变化情况,采用Likert五分量表法评价患者对术中疼痛的体验。[结果]局麻组有2例术中在椎间孔成形时因疼痛临时增加静脉强化麻醉完成手术。联合组患者均顺利完成手术,未增加镇痛药物,术后有1例出现尿潴留,经导尿治疗24 h后恢复。两组患者T1期VAS、MAP及HR评分,差异无统计学意义(P>0.05),联合组患者T2、T3和T4期VAS、MAP及HR评分均低于局麻组(P<0.05),两组患者手术各时点SpO2比较,差异无统计学意义(P>0.05)。局麻组的局麻体验评价选择好和很好的仅占36.00%,而联合组占84.00%;差异具有统计学意义(P<0.05)。[结论]局部麻醉联合骶管麻醉方案在不增加手术风险的前提下可显著改善腰椎内镜椎管内操作的疼痛控制。

[Objective]To evaluate the analgesic effects of local anesthesia combined with sacral anesthesia in percutaneous endoscopic lumbar discectomy(PELD).[Methods]From January 2016 to June 2018,50 patients who underwent PELD for lumbar disc herniation in our hospital were selected,and randomly divided into two groups.Of them,25 patients received local anesthesia only(the LA group),while the other 25 patients had local anesthesia as the LA group,combined with sacral anesthesia conducted 10 min before operation(the CA group).The visual analogue scale(VAS)for pain and mean arterial pressure(MAP),heart rate(HR),and oxygen saturation(SpO2)were recorded and compared between the two groups during the periods as the skin and soft tissue expanded(T1),the intervertebral foramen treated(T2),the annulus fibrosus and the posterior longitudinal ligament handled(T3),as well as the nerve roots released and nucleus pulposus removed(T4).In addition,5-point Likerttype scale was used for evaluation of patients experience to local anesthesia and tolerance.[Results]Two patients in the LA group had to add temporary intravenous intensive anesthesia to complete the operation due to pain intolerance during intervertebral foraminoplasty.By contrast,all patients in the CA group had operation performed smoothly without any extra analgesic measure applied,though 1 patient got urinary retention,which was resolved by catheterization and recovered 24 hours later.Although no statistically significant differences were proved between the two groups in VAS,MAP and HR during T1 stage,the LA group had significantly higher aforesaid parameters than the CA group during T2,T3 and T4 stages(P<0.05).However,no statistically significant differences were noticed in SpO2 during any stage between them(P>0.05).In term of subjective experience to the anesthetics,36%patients in the LA group reported positively,while 84%patients in the CA has positive results,there was a statistically significant difference(P<0.05).[Conclusion]Local anesthesia combined with sacral anesthesia does significantly improve the pain control in lumbar endoscopic surgery with no increase of surgical risk.