浸渍罗哌卡因和地塞米松的明胶海绵用于腰椎后路手术后镇痛临床疗效观察

Clinical effect of gelatin sponge impregnated with ropivacaine and dexamethasone for pain management after posterior lumbar surgery

目的观察浸渍罗哌卡因和地塞米松的明胶海绵用于腰椎后路手术后镇痛的临床疗效。方法选取行1~3个节段腰椎后路钉棒系统内固定+椎管减压+椎间融合手术的患者200例,随机分为A、B两组,各100例。A组于术毕关闭切口前在手术节段减压侧的椎旁及椎弓根螺钉内侧、非减压侧的多裂肌及最长肌间隙放置地塞米松和罗哌卡因浸渍的明胶海绵,B组则施以同等体积生理盐水浸渍的明胶海绵。所有患者在术前、术毕(术后1 h内)及术后24、48 h采集静脉血,测定血清P物质(SP);记录患者手术时间、术中出血量、术前及术后48 h内疼痛视觉模拟评分法(VAS)评分、术后首次下床活动时间、术前及术后第7天腰椎JOA评分、阿片类药物(地佐辛注射液)消耗量,并进行患者术后满意度调查。结果两组手术时间、术中失血量比较差异无统计学意义。术毕及术后24、48 h时血清SP水平A组低于B组(P均<0.05)。A组术后各时间点疼痛VAS评分低于B组(P均<0.05)。A组术后首次下床活动时间早于B组,术后第7天腰椎JOA评分及治疗改善率高于B组,地佐辛消耗量低于B组,患者满意程度高于B组(P均<0.05)。结论在手术节段椎旁及椎体横突上放置浸渍地塞米松和罗哌卡因的明胶海绵可有效减轻腰椎后路手术患者术后疼痛,减少阿片类药物消耗量,缩短术后卧床时间,促进功能恢复,提高治疗满意度。

Objective To observe the clinical effect of gelatin sponge impregnated with ropivacaine and dexamethasone on analgesia after posterior lumbar surgery.Methods A total of 200 patients who underwent 1 to 3 levels of posterior lumbar screw and rod system internal fixation+spinal decompression+interbody fusion were randomly divided into group A and group B,with 100 patients in each group.Gelatin sponges impregnated with dexamethasone and ropivacaine were placed at the paraspinal and medial pedicle screws on the decompression side of the surgical segment,and between the multifidus and longissimus muscles on the non-decompression sides of patients in the group A,while gelatin sponges impregnated with the same volume of saline were placed in the group B before incision closure.Venous blood was collected from all patients before and after surgery(within 1 h after surgery),24 and 48 h after surgery,and the level of serum substance P(SP)was determined.We recorded patients'age,sex,operation time,intraoperative blood loss,surgical vertebral body quantity,the American association of anesthesia(ASA)grading,preoperative and postoperative pain visual analogue scale(VAS)score within 48 h,the first time to get out of bed after surgery,lumbar JOA score before and on the seventh day after surgery,opioid consumption(dezocine),and postoperative satisfaction questionnaire results.Results There was no significant difference in the operation time or intraoperative blood loss between these two groups.At the end of operation,24 and 48 h after operation,the levels of serum SP in the group A was significantly lower than that in group B(P<0.05).The pain VAS score of group A was significantly lower than that of group B at each time point(P<0.05).The time to get out of bed for the first time in the group A was significantly earlier than that in the group B,and the score of lumbar JOA and improvement rate on the 7th day after operation in the group A were significantly higher than those in the group B;the consumption of dezocine in the group A was significantly lower than that in group B,and the satisfaction of patients in the group A was significantly higher than that in the group B(all P<0.05).Conclusion Placing gelatin sponge impregnated with dexamethasone and ropivacaine on the transverse process of vertebral body can effectively reduce postoperative pain,reduce opioid consumption,shorten postoperative bed rest time,promote functional recovery and improve treatment satisfaction.