氟比洛芬酯联合脊神经后支阻滞在腰椎后路手术后的镇痛效果观察

Efficacy of flurbiprofen axetil combined with posterior branch block of spinal nerve in Lumbar posterior surgery

目的观察氟比洛芬酯联合脊神经后支阻滞在脊柱后路手术后的镇痛效果。方法选取2018年6月-2019年3月在我院行腰椎后正中入路手术患者60例,随机分为两组,静脉组30例,采用患者自控镇痛,分次静注氟比洛芬酯和舒芬太尼;阻滞组30例,术中使用罗哌卡因在涉及手术节段进行脊神经后支阻滞,术后采用患者自控镇痛,分次静注氟比洛芬酯和舒芬太尼。观察各组术后2h、6h、12h、24h、48h静息状态和运动状态时的VAS评分(visual analogue score,VAS)。对两组间VAS评分、舒芬太尼使用量及不良反应发生率进行统计学分析。结果术后2h、6h、24h、48h阻滞组静息痛、运动痛VAS评分均显著低于静脉组(P<0.01);阻滞组舒芬太尼用量在术后24h和48h明显少于静脉组舒芬太尼用量(P<0.01);静脉组有9例患者出现不良反应,不良反应发生率31.03%,阻滞组有3例患者发生不良反应,不良反应发生率10.34%。结论静脉组和阻滞组两组术后镇痛方案均能有效缓解腰椎后路手术后急性疼痛;但阻滞组相比静脉组的镇痛效果更好,能明显减少阿片类药物用量和降低药物不良反应。

Objective To evaluate the efficacy of flurbiprofen axetil combined with block posterior branch of spinal nerve in Lumbar posterior surgery.Methods A total of 60 patients who underwent lumbar posterior median approach surgery in our hospital from June 2018 to March 2019 were selected.Patients were randomly divided into two groups:Intravenous group(30 cases),patient-controlled analgesia,intravenous injection of flurbiprofen and sufentanil.Block group(30 cases),during the operation,ropivacaine was used to block posterior branch of the spinal nerve in the surgical segment.After the operation,patient-controlled analgesia was administered intravenously with flurbiprofen and sufentanil.The VAS scores of the resting and moving states at 2 h,6 h,12 h,24 h,and 48 hwere observed.VAS score,sufentanil usage and incidence of adverse reactions between the two groups were statistically analyzed.Results VAS scores of resting pain and exercise pain in the block group were significantly lower than those in the vein group at 2 h,6 h,24 h,and 48 hafter surgery(P<0.01).Sufentanil dosage in the block group was significantly lower than that in the intravenous group at 24 hand 48 hafter surgery(P<0.01).9 patients in the venous group had adverse reactions,with an incidence of 31.03%;3 patients in the block group had adverse reactions,with an incidence of 10.34%.Conclusion Both the intravenous group and the block group could effectively relieve the acute pain after posterior lumbar surgery,but the block group had better analgesic effect than the intravenous group,and could significantly reduce opioid dosage and adverse drug reactions.