曲马多超前镇痛在局麻下胸腰段骨质疏松骨折椎体后凸成形术中的效果

目的: 探讨术前肌注曲马多用于局麻下行经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的超前镇痛效果。方法: 自2019年8月至2021年6月收治118例骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者,观察组59例,男26例,女33例;年龄57~80(67.69±4.75)岁;T₁₁ 14例,T₁₂ 12例,L₁ 18例,L₂ 15例;予PKP术前0.5 h肌肉注射曲马多100 mg。对照组59例,男24例,女35例;年龄55~77(68.00±4.43)岁;T₁₁ 19例,T₁₂ 11例,L₁ 17例,L₂ 12例;予肌肉注射等量生理盐水。记录两组手术时间和术中出血量,采用视觉模拟评分(visual analogue scale,VAS)评估两组术前(T0)及术中穿刺时(T1)、放置工作套管时(T2)、球囊扩张时(T3)、骨水泥注入椎体时(T4)、术后2 h (T5)、出院时(T6)的疼痛程度;观察头晕、恶心、呕吐等不良反应,出院时询问患者对再次行PKP手术的接受度。结果: 118例患者顺利完成经双侧椎弓根入路PKP术,术中均未使用静脉镇静镇痛药物。两组手术时间、术中出血量比较,差异无统计学意义(P>0.05)。观察组T1、T2、T3、T4、T5时的VAS较对照组降低(P<0.05);T6时的VAS比较,差异无统计学意义(P>0.05)。两组T6时的VAS较T0降低(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05),对再次行PKP术的接受度比较,差异有统计学意义(P<0.05)。结论: 术前0.5 h肌注曲马多用于在局麻下单节段胸腰段骨质疏松骨折椎体PKP术的超前镇痛效果明确,可增加患者术中及术后2 h的舒适度,提高患者手术满意度。

Effects of tramadol hydrochloride preemptive analgesia in kyphoplasty of thoracolumbar osteoporotic fractures under local anesthesia

Objective To explore preemptive analgesic effect of preoperative intramural tramadol injection in percutaneous kyphoplasty (PKP) of vertebrae following local anesthesia.Methods From August 2019 to June 2021,118 patients with thoraco lumbar osteoporotic fractures were treated and divided into observation group and control group,with 59 patients in each gruop. In observation group,there were 26 males and 33 females, aged from 57 to 80 years old with an average of (67.69±4.75)years old;14 patients on T₁₁,12 patients on T₁₂,18 patients on L₁,15 patients on L₂;tramadol with 100 mg was injected intramuscularly half an hour before surgery in observation group. In control group,there were 24 males and 35 females,aged from 55 to 77 years old with an average of (68.00±4.43) years old;19 patients on T₁₁,11 patients on T₁₂,17patients on L₁,12 patients on L₂;the same amount of normal saline was injected intramuscularly in control group. Observation indicators included operation time,intraoperative bleeding,visual analogue scale (VAS) evaluation and recording of preoperative (T0),intraoperative puncture(T1),and working cannula placement (T2) between two groups of patients,at the time of balloon dilation (T3),when the bone cement was injected into the vertebral body (T4),2 hours after the operation (T5),and the pain degree at the time of discharge(T6);adverse reactions such as dizziness,nausea and vomiting were observed and recorded;the record the patient''s acceptance of repeat PKP surgery.Results All patients were successfully completed PKP via bilateral pedicle approach,and no intravenous sedative and analgesic drugs were used during the operation. There was no significant difference in preoperative general data and VAS(T0) between two groups (P>0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). VAS of T1,T2,T3,T4 and T5 in observation group were all lower than those in control group(P<0.05),and there was no significant difference in T6 VAS (P>0.05). T6 VAS between two groups were significantly lower than those of T0,and the difference was statistically significant (P<0.05). There was no significant difference in incidence of total adverse reactions between two groups (P>0.05). There was a statistically significant difference in the acceptance of repeat PKP surgery (P<0.05).Conclusion Half an hour before operation,intramuscular injection of tramadol has a clear preemptive analgesic effect for PKP of single-segment thoracolumbar osteoporotic fracture vertebral body under local anesthesia,which could increase the comfort of patients during operation and 2 hours after operation,and improve patients satisfaction with surgery.