亚麻醉剂量艾司氯胺酮对腰椎手术患者术后镇痛的影响

Effect of subanesthetic dose of esketamine on postoperative analgesia in patients undergoing lumbar surgery

目的观察亚麻醉剂量艾司氯胺酮对腰椎手术患者术后镇痛的影响。方法70例腰椎椎管狭窄行腰椎融合术的患者随机分为两组。ES组(34例)切皮前5min静脉注射艾司氯胺酮0.25mg/kg,术中以0.12mg·kg^(-1)·h^(-1)泵入;C组(36例)予等容量生理盐水作对照。比较两组术后48h内舒芬太尼用量和患者自控镇痛(PCA)次数,评估术前1d及术毕30min、12h、24h和48h的疼痛数字评分表(NRS)评分。记录两组患者的麻醉苏醒情况及术后不良反应的发生情况。结果ES组患者术后48h内舒芬太尼用量和PCA次数均少于C组[(1.58±0.20)μg/kg vs.(1.87±0.26)μg/kg和(12.3±4.0)次vs.(18.1±4.9)次](P<0.05)。两组各时间点NRS评分、麻醉苏醒指标及术后不良反应发生比例差异均无统计学意义(P>0.05)。结论术中应用亚麻醉剂量艾司氯胺酮可增强腰椎融合术患者的术后镇痛,减少术后阿片类药物的用量。

Objective To observe the effect of subanesthetic dose of esketamine on postoperative analgesia in the patients undergoing lumbar surgery.Methods Seventy patients with lumbar spinal stenosis undergoing lumbar fusion surgery were randomly divided into two groups.Group ES received intravenous injection of esketamine 0.25mg/kg 5minutes before skin incision,which was followed by pumping esketamine 0.12mg·kg^(-1)·h^(-1) during surgery.Group C received same volume of normal saline instead of esketamine as the control.The dosage of sufentanil within 48hours after surgery and the number of patient-controlled analgesia(PCA)were compared between the two groups.Numerical rating scale(NRS)was used to evaluate pain scores one day before and 30minutes,12hours,24hours and 48hours after surgery.Anesthesia recovery and postoperative adverse reactions were recorded.Results The dosage of sufentanil within 48hours after operation and the PCA number were less in group ES than those in group C[(1.58±0.20)μg/kg vs.(1.87±0.26)μg/kg and(12.3±4.0)times vs.(18.1±4.9)times](P<0.05).There were no statistical differences in NRS score at each time point after surgery,anesthesia recovery indexes,and the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion In the patients undergoing lumbar fusion surgery,intraoperative application of subanesthetic dose of esketamine can enhance postoperative analgesia and reduce the consumption of postoperative opioids.