比较硬膜外麻醉与局部浸润麻醉在经皮脊柱内镜治疗腰椎间盘突出症患者中的应用效果

Comparison of the analgesic efficacy between epidural block and local infiltration anesthesia for patients with lumbar disc herniation underwent percutaneous spine endoscopy

目的:比较0.2%罗哌卡因硬膜外麻醉与0.5%罗哌卡因局部浸润麻醉在经皮脊柱内镜治疗腰椎间盘突出症中的应用效果。方法:收集杭州市临平区第一人民医院骨科脊柱病区2018年1月至2019年12月期间,择期行单节段经皮脊柱内镜治疗腰椎间盘突出症患者73例,ASA分级Ⅰ~Ⅲ级,年龄与性别不限。根据随机数字表法将其随机分为两组,硬膜外麻醉组(A组,40例)和局部麻醉组(B组,33例)。A组以0.2%罗哌卡因10~20 ml行硬膜外麻醉,观察15 min无不良反应,行内窥镜手术;B组术者采用0.5%罗哌卡因沿内窥镜入路逐层注射至硬膜外,直接入器械进行手术。两组患者在麻醉前15 min均进行右美托咪定滴定,每日总量不超过1.0 μg/kg,后以0.5 μg·kg -1·h -1维持,观察围术期两组患者生命体征,记录各组患者手术时间,X线透视次数,术前、经皮穿刺、椎间孔成型、髓核摘除时及术后1 d患者视觉模拟评分(VAS),罗哌卡因使用量,术后下地时间。 结果:B组2例患者因疼痛终止手术,退出研究。A组手术时间少于B组[(93.7±14.1)min比(145.8±22.4)min, t=-11.92, P<0.001];A组X线透视次数少于B组[(6.9±3.2)次比(12.4±3.1)次, t=-5.84, P<0.001];A组罗哌卡因药使用量少于B组[(55.0±7.1)mg比(151.5±2.7)mg, t=-22.54, P<0.001];两组下地时间及术前、术后1 d时VAS评分差异均无统计学意义( P均>0.05),其余时点A组VAS评分均较B组低( P均<0.05)。 结论:0.2%罗哌卡因行硬膜外麻醉较0.5%罗哌卡因局部麻醉应用于经皮脊柱内镜下椎间盘切除术更安全、有效。

To compare the analgesic efficacy of epidural anesthesia with 0.2%ropivacaine and local infiltration anesthesia with 0.5%ropivacaine for patients with lumbar disc herniation underwent the percutaneous spine endoscopy therapy.Methods Seventy-three patients with lumbar disc herniation,ASA grade I to II,regardless of age and gender,underwent selective single-segment percutaneous endoscopic surgery,from January 2018 to December 2019,in the Depatment of Orthopedics Spinal Ward,First People's Hospital of Linping District,were included in this study,and randomly divided into epidural anesthesia group(group A,40 cases)and local infiltration anesthesia group(group B,33 cases)by random number table.Patients were received epidural block with 10-20 ml of 0.2%ropivacaine in the group A,and received local infiltration anesthesia with O.5%ropivacaine along the endoscopic approach layer in group B.Dexmedetomidine titration was performed 15 minutes before anesthesia in both groups,and the total daily amount did not exceed 1.0μg·kg',and then was maintained at O.5μg•kg^(-1).h^(-1).Physical signs,operation time,X-ray fluoroscopy times,and visual analogue scale(VAS)during preoperative,percutaneous puncture,foraminoplasty,nucleus pulposus removal at the first day after the operation were recorded.The amount of ropivacaine,and the postoperative landing time were also recorded.Results Two patients terminated the operation in group B due to unbearable pain,and quit the study.The operation time was shorter in the group A than that in the group B[(93.7±14.1)min vs.(145.8±22.4)min,t=-11.92,P<0.001];the number of X-ray fluoroscopy was less in the group A than that in the group B[(6.9±3.2)times vs.(12.4±3.1)times,t=-5.84,P<0.001];ropivacaine used was less in the group A than that in the group B[(55.0±7.1)mg vs.(151.5±2.7)mg,t=-22.54,P<0.001];the landing time and VAS before and 1 day after the operation are comparable between the two groups,but VAS was lower in the group A than that in the group B at other time points(all P<0.05).Conclusion Epidural anesthesia with 0.2% ropivacaine is safer and more effective than local anesthesia with 0.5% ropivacaine for patients with lumbar disc herniation underwent percutaneous spine endoscopic discectomy forthe treatment.