CT造影动态评估椎间孔镜手术椎间孔阻滞中利多卡因扩散范围

Evaluation of the diffusion range of lidocaine in interforaminal block and transforaminal endoscopic spine surgery using dynamic CT radiography

目的采用CT下动态观察腰椎椎间孔镜手术椎间孔阻滞时不同容量利多卡因的扩散范围,为探讨该类手术中椎间孔阻滞利多卡因的适宜容量提供依据。方法2018年1月-2019年9月于本院接受单节段椎间孔镜手术患者52例,以随机数字法将其分为A组和B组各26例,分别在CT引导穿刺下注入1%利多卡因与碘海醇造影剂混合物5 mL和10 mL,观察2 min、4 min、6 min时的扩散范围。结果5 mL利多卡因2 min可分布至责任椎间盘同侧椎间孔、神经根管、侧隐窝;4 min可分布至硬膜外腔、责任椎间盘对侧侧隐窝,及相邻上下两个节段同侧椎间孔、侧隐窝和黄韧带下部分硬膜外腔背侧;6 min可分布至相邻上下两个节段同侧椎间孔、神经根管、侧隐窝及黄韧带下广泛硬膜外腔背侧。10 mL利多卡因2 min后可分布至责任椎间盘两侧椎间孔和神经根管、硬膜外腔、相邻上下2个节段同侧椎间孔和神经根管;4 min后可分布至相邻上下2个节段两侧椎间孔、神经根管、侧隐窝以及黄韧带下广泛的硬膜外腔;6 min后可分布至相邻上下3个节段同侧侧椎间孔、神经根管、侧隐窝及黄韧带下广泛的硬膜外腔背侧。结论腰椎椎间孔镜手术时,椎间孔阻滞可以达到良好的阻滞效果;不同容量的1%利多卡因4~6 min可达到最大扩散范围,其中5 mL容量可满足单节段椎管扩大术的镇痛范围,10 mL容量可以满足双节段椎管扩大术的镇痛范围。

Objective To determine the optimum volume of lidocaine solution in transforaminal endoscopic spine surgery under the intra-operative guidance of CT,so as to provide evidence for intervertebral foramen block of this kind of surgery.Methods Fifty-two patients who underwent single segment transforaminal endoscopic spine surgery from January 2018 to September 2019 in our hospital were enrolled.The patients were randomly divided into group A and group B,with 26 cases in each group.We injected the mixed liquid of 1%lidocaine solution and iohexol contrast agent(5 mL in group A and 10 mL in group B)to the nerve root under CT guidance,and observed the diffusion range at 2 min,4 min and 6 min after injection.Result 5 mL 1%lidocaine solution was distributed to the ipsilateral foramen,nerve root canal and lateral recess of the responsible intervertebral disc in 2 minutes,to the opposite recess of the responsible intervertebral disc in 4 minutes,to the ipsilateral foramen,lateral recess and the dorsal part of the extradural space under the yellow ligament in the adjacent upper and lower segments,and to the ipsilateral foramen,nerve root canal,lateral recess and extensive dura under the yellow ligament in 6 minutes.10 mL 1%lidocaine solution was distributed to the intervertebral foramen and nerve root canal on both sides of the responsible intervertebral disc,the extradural space,the ipsilateral intervertebral foramen and nerve root canal of the adjacent upper and lower segments in 2 minutes.It was distributed to the intervertebral foramen on both sides of the adjacent upper and lower segments,the nerve root canal,the lateral recess and the extensive extradural space under the ligamentum flavum in 4 minutes.It was distributed to the same side intervertebral foramen of the adjacent upper and lower segments,the nerve root canal,lateral recess and the dorsal side of the extradural space under the ligamentum flavum in 6 minutes.Conclusion Intervertebral foramen block in transforaminal endoscopic spine surgery can obtain excellent and good anesthetic effect.1%lidocaine with different volume can reach the maximum diffusion range in 2-6 minutes,among which 5 mL volume is sufficient to the analgesia range for single segment spinal canal enlargement,and 10 mL volume is sufficient to the analgesia range for double segment spinal canal enlargement.