脊神经后支阻滞在老年人腰椎后路椎间融合术多模式镇痛方案中的应用  

Multimodal analgesia via dorsal ramus of spinal nerve block in elderly during posterior lumbar interbody fusion

作　　者：黄春燕 黄凯 王晓瑛 王娟娟 HUANG Chun yan;HUANG Ka;WANG Xiao ying;WANG Juan juan(Deparment of Anesthesiology,Jing＇an District ZhabeiC entralH ospital,Shanghai200070,China;Department of Spine Surgeu,Jing＇an District Zhabei Central Hospital,Shanghai200070,China)

机构地区：[1]上海市静安区闸北中心医院麻醉科,上海200070 [2]上海市静安区闸北中心医院脊柱外科,上海200070

出　　处：《脊柱外科杂志》2018年第3期152-156,共5页Journal of Spinal Surgery

摘　　要：目的探讨联合罗哌卡因脊神经后支阻滞多模式镇痛方案在老年人后路腰椎椎间融合术(PLIF)围手术期镇痛中的应用。方法行PLIF的老年患者(年龄≥65岁)60例,随机分为对照组(A组,n=20)、常规多模式镇痛组(B组,n=20)和脊神经后支阻滞多模式镇痛组(C组,n=20),记录3组患者术前6 h及术后6、12、24、48、72 h及1周时疼痛视觉模拟量表(VAS)评分,术后1、3、7 d及出院时的运动阻滞(Bromage)评分;统计不良反应发生率和额外使用镇痛药物的例数。结果术前6 h,VAS评分B、C组低于A组,差异有统计学意义(P<0.05);术后6、12、24 h,C组低于A、B组,差异有统计学意义(P<0.05);术后48 h,各组间差异无统计学意义(P>0.05);术后72 h及1周,B、C组低于A组,差异有统计学意义(P<0.05)。术后1 d,Bromage评分C组低于A、B组,差异有统计学意义(P<0.05);术后3、7 d及出院时,各组间差异无统计学意义(P>0.05)。B、C组不良反应发生率低于A组,差异有统计学意义(P<0.05);额外使用镇痛药物例数C组<B组<A组,各组间差异均有统计学意义(P<0.05)。结论联合应用罗哌卡因脊神经后支阻滞的多模式镇痛方案能有效缓解老年人PLIF围手术期疼痛,且不影响运动功能。Objective To explore the application of multimodal analgesia including the dorsal ramus of spinal nerve block with ropivacaine in perioperative analgesia of posterior lumbar interbody fusion（PLIF） in the elderly. Methods Sixty patients with routine PLIF（age ≥ 65 years） were randomly and equally divided into control group（group A）, conventional multimodal analgesia group（group B） and dorsal ramus of spinal nerve block group（group C）. The visual analogue scale（VAS） scores at preoperative 6 h and postoperative 6, 12, 24, 72 h and 1 week were evaluated in the 3 groups, and the moto block rating （Bromage） at postoperative 1, 3 and 7 d were recorded. The incidence of adverse reaction and the cases with additional use of analgesic drugs were recorded. Results The VAS scores at preoperative 6 h of groups B and C were lower than that of group A, and the difference was statistically significant（P〈0.05）. The VAS scores at postoperative 6, 12 and 24 h of group C were lower than those of groups A and B, and the differences were statistically significant（P〈0.05）. The VAS scores at postoperative 72 h and 1 week of groups B and C were lower than that of group A, and the differences were statistically significant（P〈0.05）. The VAS scores at postoperative 48 h showed no statistical difference between 3 groups（P〉0.05）. The Bromage score at postoperative 1 d of group C was lower than that of groups A and B, and the differences were statistically significant（P〈0.05）, which at postoperative 3 and 7 d showed no statistical difference between 3 groups（P〉0.05）. The incidences of adverse reactions of groups B and C were lower than that of group A, and the differences were statistically significant（P〈0.05）. The cases additional use of analgesic drug：group C 〈 group B 〈 group A, and the differences between 3 groups were statistically significant（P〈0.05）. Conclusion Combined use of ropivacaine multimodal analgesia via dorsal ramus of spinal nerve block can eff

关 键 词：腰椎 脊柱融合术 麻醉 局部 镇痛 老年人 

分 类 号：R681.533[医药卫生—骨科学]