腰椎融合后的多模式镇痛

背景：疼痛生理病理机制包括中枢和多个外周神经传导机制和环节,治疗手段上经历了传统的镇痛药物注射、口服镇痛药物、自控硬膜外镇痛、自控静脉镇痛等方法,减轻了临床疼痛,但仍有一定的不良反应发生。多模式镇痛方案从多个机制层面达到完全镇痛的目的,具有一定的临床创新性,但临床疗效及安全性有待于进一步深入研究。目的：探讨切口周围注射复合麻醉药物的多模式镇痛方案在腰椎后路融合后的镇痛效果及安全性。方法：2013年4月至2014年4月共收治行腰椎后路融合患者78例,随机分为两组,试验组39例采用切口周围注射多模式镇痛药物（吗啡＋酮咯酸＋罗哌卡因＋肾上腺素）治疗,对照组39例局部注射生理盐水。所有患者记录融合后即刻、6 h、12 h、24 h、48 h、7 d的目测类比评分、Ramsay镇静评分以及融合后首次吗啡使用时间、吗啡使用量及不良反应。结果与结论：两组患者间在年龄、性别、主要病因、体质量指数、手术节段方面差异无显著性意义,具有统计学可比性。在融合后6,12,24,48 h内,试验组目测类比评分明显降低（P〈0.05）,Ramsay镇静评分较对照组升高（P〈0.05）。但在融合后第7天时两组目测类比评分差异无显著性意义。试验组融合后首次吗啡使用时间较对照组明显延迟（P=0.002）,同时吗啡使用量也明显降低（P=0.041）,有效控制了临床围手术期的药物使用并保证了镇痛的效果。提示对于腰椎后路融合后患者,多模式镇痛可作为一种安全有效的镇痛方案使用,可以显著降低融合后疼痛程度而不增加不良反应的发生,提高患者的满意度。

Multimodal pain control protocol after lumbar spinal fusion

BACKGROUND： Pathophysiological mechanisms of the pain are mediated by the central and peripheral nerve conduction mechanisms, the commonly used treatment includes analgesic drugs injection, oral analgesic drugs, patient-controlled epidural analgesia, and patient-controlled intravenous analgesia. These methods can reduce clinical pain, but induce some adverse reactions. Multimodal pain control protocol contributes to achieve complete analgesic effect and has clinical innovation significance. Further research is needed to explore clinical efficacy and safety. OBJECTIVE： To evaluate the therapeutic effect and safety of muItimoda（ pain control protocol on postoperative analgesia of lumbar spinal fusion. METHODS： Between April 2013 and April 2014, 78 patients undergoing lumbar spinal fusion were chosen for this research, and randomly assigned to experimental group with 39 patients and control group with 39 patients. The experimental group was treated with local injection of morphine, ketorolac, ropivacaine and adrenalin around the incision; the control group was treated with local injection of saline. The VAS score, Ramsay score, the first morphine time, the dose of morphine and adverse reactions immediately and at 6, 12, 24, 48 hours and 7 days after fusion were recorded.RESULTS AND CONCLUSION： There was no significant difference between the two groups in terms of age, gender, bone mass index, pathogeny and surgical segment. At 6, 12, 24, 48 hours after fusion, the VAS scores in the experimental group were lower （P 〈 0.05） and the Ramsay scores were higher than the control group （P 〈 0.05）. The VAS scores showed no significant difference between the two groups at 7 days after fusion. The first morphine time was obviously delayed （P=0.002） and the dose of morphine was reduced in the experimental group （P=0.041）, which effective controlled perioperative drug use and ensured anesthesia effect. Multimodal pain control protocol is safe and effective Jn treatment of postoperative pain after tu