经皮椎间孔镜下腰椎间盘切除术的麻醉药物配方镇痛效果的随机对照研究

The Analgesic Effect of Formulations of Anesthetic Drugs in Percutaneous Transforaminal Endoscopic Lumbar Discectomy: A Randomized Controlled Trial

目的评价两种局部浸润麻醉药物配方对施行经皮椎间孔镜下腰椎间盘切除术患者术中的镇痛效果。方法 2018年10月~2019年3月在我院因单节段腰椎间盘突出症接受经皮椎间孔镜下腰椎间盘切除术(PTELD)治疗的患者纳入本研究,随机分为两组:A组麻醉方法为浓度1%的利多卡因稀释溶液局部浸润麻醉;B组为在A组的基础上加入盐酸罗哌卡因注射液100 mg局部浸润麻醉同时在手术开始前10分钟静脉注射枸橼酸舒芬太尼注射液10 ug(0. 2 m L)。采集每例患者术中椎间孔成形期VAS评分和纤维环减压期VAS评分用于评价术中镇痛效果。结果共78例患者纳入研究,A组40例,B组38例。椎间孔成形期B组在平均疼痛VAS评分(2. 03±0. 59)及峰值疼痛VAS评分(3. 39±0. 95)上都显著低于A组(4. 07±0. 62及6. 08±1. 33)。纤维环减压期两组间平均疼痛VAS评分和峰值VAS评分无显著性差异。两组患者术后均未出现麻醉及手术相关的并发症。结论采用利多卡因及罗哌卡因混合局麻联合静脉注射舒芬太尼的这一药物配方在未增加手术风险的前提下可明显提高经皮椎间孔镜手术的镇痛效果。

Objective To evaluate the analgesic effect of two local infiltrating anesthetic formulations on patients undergoing percutaneous transforaminal endoscopic lumbar discectomy.Methods Patients who received percutaneous transforaminal endoscopic lumbar discectomy(PTELD)for single-segment lumbar disc herniation in our hospital from October 2018 to March 2019 were included in this study and were randomly divided into two groups.In group B,100 mg local infiltration anesthesia of ropivacaine hydrochloride injection was added on the basis of group A,and 10 ug(0.2 ml)of sufentanil citrate injection was injected intravenously 10 minutes before the operation.The intraoperative VAS score during foramoplasty and the VAS score during annular decompression were collected from each patient to evaluate the intraoperative analgesic effect.Results A total of 78 patients were included in the study,including 40 patients in group A and 38 patients in group B.The average VAS score(2.03±0.59)and peak VAS score(3.39±0.95)of group B were significantly lower than those of group A(4.07±0.62 and 6.08±1.33)during the intervertebral foramoplasty stage.There was no significant difference in mean and peak VAS scores between the two groups during annular decompression.There were no postoperative complications related to anesthesia and operation in both groups.Conclusions The combination of local anesthesia with lidocaine and ropivacaine and intravenous sufentanil can significantly improve the analgesic effect of percutaneous transforaminal endoscopic surgery without increasing the risk of surgery.