术中椎旁肌封闭对控制腰椎手术后疼痛的疗效观察

【目的】探讨术中在椎旁肌肉中注射药物对控制腰椎手术后疼痛的治疗作用。【方法】153例腰椎后路手术患者,分为肌肉封闭组78例,注射利多卡因+罗哌卡因;对照组75例,不作封闭治疗。分别观察术后不同时间两组VAS疼痛评分、住院期间肢体感觉、肌力、腱反射、平卧翻身及下地行走时间等。【结果】术后1d、1周、2周VAS评分,椎旁肌封闭组为(5.75±0.76)、(4.22±0.80)、(3.37±0.79),对照组则为(7.82±0.69)、(6.32±0.79)、(5.53±0.79),各时间点相比差异有统计学意义(P<0.01)。椎旁肌封闭组对止痛药物的依赖性低,患者术后平卧翻身时间(1.85±0.31)d和下地行走时间(3.09±0.39)d均较对照组(2.09±0.36)d和(3.47±0.43)d缩短,差异有统计学意义(P<0.01)。观察期间封闭组没有发现明显的胃肠道反应、心血管系统异常反应、尿潴留等不良反应。【结论】术中椎旁肌封闭能有效控制腰椎手术后的早期疼痛反应疼痛,对术后功能恢复有利。

Effect of intraoperative block of paraspinal muscle on the manage of back pain after lumbar vertebrae operation

[ Objective] To study the effect of drug injection into the paraspinal muscle on back pain after lumbar vertebrae operation. [Methods] A total of 153 patients with lumbar diseases were randomly assigned to 2 groups. Blocking group （ n = 78） received intrathecal injection of 10ml 0.75% ropivacaine and 10ml 2% lidocaine to block the paraspinal muscle. Control group （ n = 75） received no paraspinal muscle block. The patients were evaluated for the pain by visual analogue scale （VAS） and the function of the nerve roots involved. [Results] The paraspinal muscle block group needed smaller dose of painkillers, with faster postoperative recovery of functions, while in the control group, some patients still suffered from pain shortly after the operation. The VAS scores were markedly lower in paraspinal muscle block group（5.75 ± 0.76, 4.22 ± 0.80 and 3.37 ± 0.79 in ld, lw and 2w after operation） than in the control group（7.82 ± 0.69, 6.32 ± 0.79 and 5.53 ± 0.79, respectively） （ P 〈 0.01）. There were not obvious side effects such as gastrointestinal reaction, paradoxical reaction of cardiovascular system and uroschesis. [Conclusion ]The intraoperative block of paraspinal muscle can effectively control back pain in the early period of lumbar vertebrae operation.