纳洛酮胸腰筋膜平面阻滞在TLIF术后镇痛效果

Analgesic effect of naloxone in thoracolumbar interfascial plane block during perioperative period of transforaminal lum⁃bar interbody fusion

[目的]探讨小剂量纳洛酮胸腰筋膜平面(thoracolumbar interfascial plane,TLIP)阻滞在经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)术后的镇痛效果。[方法]2020年5月—2023年5月腰椎退行性疾病在全麻下行TLIF的82例患者纳入本研究。根据术前医患沟通结果,40例采用常规TLIP阻滞(常规组),另外42例采用小剂量纳洛酮TLIP阻滞(纳洛酮组),比较两组围手术期临床与镇痛资料。[结果]两组手术时间、术中出血量和不良反应发生率差异无统计学意义(P>0.05)。两组术后2~48 h VAS评分均先上升后下降,但纳洛酮组6、24、48 h的VAS评分均显著低于常规组(P<0.05)。此外,纳洛酮组在首次补救镇痛[(10.5±1.8)h vs(6.4±1.6)h,P<0.001]、PCIA按压次数[(6.4±0.9)次vs(8.1±1.5)次,P<0.001]、舒芬太尼剂量[(72.6±14.6)μg vs(84.5±17.6)μg,P=0.001]、额外镇痛次数[(1.2±0.4)次vs(1.8±0.2)次,P<0.001]均显著优于常规组。[结论]小剂量纳洛酮TLIP阻滞能够有效缓解TLIF术后早期疼痛症状,减少术后镇痛药物使用量及次数。

[Objective]To investigate the clinical outcomes of low-dose naloxone in thoracolumbar interfascial plane(TLIP)block dur⁃ing perioperative period of transforaminal lumbar interbody fusion(TLIP).[Methods]A total of 82 patients who were undergoing TLIF under general anesthesia for lumbar degenerative diseases from May 2020 to May 2023 were included in this study.According to the preoperative doctor-patient communication,40 patients received conventional TLIP block(conventional group),while other 42 cases received low-dose naloxone in TLIP block(naloxone group).The perioperative clinical and analgesic data of the two groups were compared.[Results]There were no significant differences in operation time,intraoperative blood loss,incidence of adverse reactions between the two groups(P>0.05).The VAS scores in both groups increased firstly and then decreased in the period from 2 hours to 48 hours after surgery.However,the nalox⁃one group was marked significantly lower VAS scores 6,24 and 48 hours than the conventional group(P<0.05).In addition,the naloxone group proved significantly superior to the conventional group in terms of the time of the first remedial analgesia use[(10.5±1.8)hours vs(6.4±1.6)hours,P<0.001],the number of PCIA press[(6.4±0.9)times vs(8.1±1.5)times,P<0.001],sufentanil doses[(72.6±14.6)μg vs(84.5±17.6)μg,P=0.001],and the number of additional analgesia[(1.2±0.4)times vs(1.8±0.2)times,P<0.001].[Conclusion]TLIP block with low-dose naloxone can effectively relieve early pain symptoms,and reduce the use and frequency of postoperative analgesics during periop⁃erative period of TLIF.