脊神经后内支阻滞对腰椎骨折术后镇痛的影响

Effect of intraoperative medial branch of dorsal ramus block on postoperative analgesia of lumbar fractures

目的探讨术中脊神经后内支阻滞对腰椎骨折术后镇痛效果的影响。方法选取全身麻醉下行多裂肌入路腰椎骨折切开复位内固定术患者100例,男49例,女51例,年龄20~75岁,BMI 19~27 kg/m^2,ASAⅠ或Ⅱ级。随机分为两组:脊神经后内支阻滞组(D组)和对照组(C组),每组50例。D组于术毕缝合前在手术腰椎节段双侧骨纤维管内口处分别注射0.5%罗哌卡因1~1.5 ml;C组不予注射。术毕所有患者行PCIA。记录术后腰酸、腰部架空感不适;术后1、6、12、24、48 h静息和活动时VAS评分;术后48 h PCIA按压次数,追加镇痛次数;术后48 h嗜睡、头晕、腹胀、恶心呕吐等不良反应。结果 D组腰酸、腰部架空感不适发生率明显低于C组(P<0.05);D组静息和活动时VAS评分明显低于C组(P<0.01);D组术后48 h PCIA按压次数、追加镇痛次数明显少于C组(P<0.01)。两组术后不良反应发生率差异无统计学意义。结论脊神经后内支阻滞联合PCIA可以更好缓解腰椎骨折内固定术患者术后疼痛,腰酸、腰部架空感不适发生率更低。

Objective To explore theeffect of intraoperative medial branch of dorsal ramus block for postoperative analgesia in lumbar fractures. Methods A total of 100 cases of open reduction and internal fixation of lumbar fracture with multifidus muscle approach under general anesthesia, including 49 males and 51 females, aged 20-75 years, BMI 19-27 kg/m^2, falling into ASA physical status Ⅰor Ⅱ,were selected. The patients were randomly divided into medial branch of dorsal ramus block group(group D) and control group(group C), with 50 cases in each group. In group D, 0.5% ropivacaine 1-1.5 ml was injected into the inner orifice of bilateral bone fiber tube of lumbar vertebrae at the end of surgery;group C was not injected. All patients received PCIA after operations. The postoperative backache and discomfort of waist overhead, the VAS of 1, 6, 12, 24, 48 h at rest and turning over after operation, the frequency of PCIA and rescue analgesic administrations and the occurrence of adverse reactions such as lethargy, dizziness, abdominal distension, nausea and vomiting were recorded 48 h after operation. Results The incidence of backache and waist discomfort in group D was significantly lower than that in group C(P<0.05). The VAS of resting and turning overin group D was significantly lower than that in group C(P<0.01). The frequency of PCIA and rescue analgesic administrations in group D were significantly less than that in group C(P<0.01). There was no significant difference in the incidence of postoperative adverse reactions between the two groups. Conclusion Medial branch of dorsal ramus block combined with PCIA can better relieve the postoperative pain in patients with lumbar fracture internal fixation, and the incidence of waist soreness and waist overhead is lower.