“鸡尾酒”局部浸润镇痛在单节段腰椎后路椎间融合术中的镇痛疗效

Analgesic Effect of "Cocktail" Local Infiltration Analgesiain Single-Segment Posterior Lumbar Interbody Fusion

目的 比较单节段腰椎后路融合术中“鸡尾酒”局部浸润对术后早期镇痛的临床疗效。方法 选取2019年12月-2022年12月宿州市第一人民医院骨科收治的86例行单节段腰椎后路椎间融合术的腰椎退行性疾病患者,根据治疗方式不同分为鸡尾酒组和对照组,每组43例。鸡尾酒组手术结束后于切口两侧肌肉筋膜和皮下组织注射鸡尾酒液50 ml(1%罗哌卡因89.4 mg、氟比洛芬酯50 mg、肾上腺素0.25 mg),对照组手术结束后用生理盐水注射50 ml。比较两组术后VAS疼痛评分、补救镇痛用药、心率及血压变化、术后下床时间、术后腰背肌开始锻炼时间及不良反应发生情况。结果 鸡尾酒组术后12、18、24、36、48 h静息VAS评分低于对照组(P<0.05);鸡尾酒组术后12、18、24、36、48、72 h翻身VAS评分低于对照组(P<0.05);鸡尾酒组共有12例患者术后使用补救镇痛药物,共使用15次,而对照组有23例患者使用急性镇痛药物,共计29次;鸡尾酒组术后下床活动时间、术后腰背肌锻炼时间早于对照组(P<0.05);两组术后住院时间比较,差异无统计学意义(P>0.05);鸡尾酒组患者满意度高于对照组(P<0.05);两组干预前后心率、平均动脉压比较,差异无统计学意义(P>0.05);两组患者术后未出现不良事件。结论 “鸡尾酒”局部浸润镇痛在单节段腰椎后路椎间融合术中的镇痛疗效良好,可延长术后镇痛时间,提高患者满意度,有利于患者术后早期康复,且不影响心率及血压变化,应用安全性较高。

Objective To compare the clinical efficacy of"cocktail"local infiltration in single-segment posterior lumbar fusion for early postoperative analgesia.Methods From December 2019 to December 2022,86 patients with lumbar degenerative diseases who underwent single-segment posterior lumbar interbody fusion in the Department of Orthopaedics,Suzhou First People's Hospital were selected.According to different treatment methods,they were divided into cocktail group and control group,with 43 patients in each group.In the cocktail group,50 ml of cocktail solution(1%ropivacaine 89.4 mg,flurbiprofen axetil 50 mg,epinephrine 0.25 mg)was injected into the muscle fascia and subcutaneous tissue on both sides of the incision after the operation.In the control group,50 ml of normal saline was injected after the operation.The postoperative VAS pain score,remedial analgesic medication,heart rate and blood pressure changes,postoperative ambulation time,postoperative back muscle exercise time and adverse reactions were compared between the two groups.Results The resting VAS score of the cocktail group was lower than that of the control group at 12,18,24,36 and 48 h after operation(P<0.05).The VAS score of turning over in the cocktail group was lower than that in the control group at 12,18,24,36,48 and 72 h after operation(P<0.05).A total of 12 patients(15 times)in the cocktail group were used remedial analgesic drugs after surgery,while 23 patients(29 times)in the control group were used acute analgesic drugs;the postoperative ambulation time and postoperative back muscle exercise time in the cocktail group were earlier than those in the control group(P<0.05).There was no significant difference in postoperative hospital stay between the two groups(P>0.05).The satisfaction of patients in the cocktail group was higher than that in the control group(P<0.05).There was no significant difference in heart rate and mean arterial pressure between the two groups before and after intervention(P>0.05).No adverse events occurred in the two groups after operation.Conclusion The analgesic effect of"cocktail"local infiltration analgesia in single-segment posterior lumbar interbody fusion is good,which can prolong the postoperative analgesia time,improve patient satisfaction,and is conducive to early postoperative rehabilitation of patients.Meanwhile,it does not affect heart rate and blood pressure changes,and has high application safety.