侧隐窝入路单侧单次硬膜外麻醉在经皮穿刺椎间孔镜腰椎间盘切除术中的镇痛效果  

The analgesic efficacy of single lateral epidural blockade via lateral recess approach for percutaneous endoscopic lumbar discectomy in the treatment of patients with lumbar disc herniation

作　　者：翁泽林 刘兴鹏 罗凯 杨婧 陈志吉 姚昕 张光辉 Weng Zelin;Liu Xingpeng;Luo Kai;Yang Jing;Chen Zhiji;Yao Xin;Zhang Guanghui(Department of Painology,The Second Affiliated Hospital of Xiamen Medical College,Xiamen City,Fujian Province 361021,China;Department of Painology,Longyan Boai Hospital,Longyan City,Fujian Province 364000,China)

机构地区：[1]厦门医学院附属第二医院疼痛科,厦门市361021 [2]龙岩博爱医院疼痛科,福建省龙岩市364000

出　　处：《中华疼痛学杂志》2022年第6期750-756,共7页Chinese Journal Of Painology

摘　　要：目的:评价侧隐窝入路单次硬膜外麻醉在经皮穿刺椎间孔镜腰椎间盘切除术(PELD)中的应用效果。方法:收集2019年11月至2020年11月在厦门医学院附属第二医院疼痛科、龙岩博爱医院疼痛科经椎间孔镜侧方入路治疗的腰椎间盘突出症患者60例,性别不限,其中龙岩博爱医院疼痛科30例为局麻组,厦门医学院附属第二医院疼痛科30例为侧隐窝组。局麻组采用局部麻醉下PELD手术治疗,侧隐窝组在术中采用侧隐窝入路单侧硬膜外麻醉加局部麻醉下PELD手术治疗。术中评估两组患者椎间孔成型时及神经减压时数字等级评分(NRS)、电凝刺激神经反应及麻醉操作时间,术后用改良Bromage评分法评估术后一过性下肢功能障碍,并统计并发症。结果:两组患者的一般资料比较差异无统计学意义( P均>0.05)。侧隐窝组患者椎间孔成型时NRS评分低于局麻组[(1.7±0.9)分比(3.5±1.0)分],差异有统计学意义( t=7.49, P<0.001)。两组患者神经减压操作时NRS评分无统计学差异( t=1.30, P=0.198)。两组患者术中电凝刺激神经反应、改良Bromage评分、术后并发症和麻醉操作时间差异均无统计学意义( P均>0.05)。 结论:侧隐窝入路单侧单次硬膜外麻醉较局部麻醉能更有效地减轻经皮穿刺椎间孔镜腰椎间盘切除术中疼痛。Objective To explore the efficacy of epidural blockade via lateral recess approach for percutaneous endoscopic lumbar discectomy(PELD)in the treatment of patients with lumbar disc herniation.Methods Sixty patients with lumbar disc herniation,both sexes,treated in Department of Painology,The Second Affiliated Hospital of Xiamen Medical College and Longyan Boai Hospital,from November 2019 to November 2020,were enrolled in this study.Thirty patients were treated with PELD under local anesthesia in Longyan Boai Hospital(local anesthesia group,n=30),the other thirty patients were treated with PELD under local anesthesia combined with single unilateral epidural blockade via lateral recess approach during operation in The Second Affiliated Hospital of Xiamen Medical College(lateral recess group,n=30).The analgesic effect was assessed by numerical rating scale(NRS)during the process of foraminoplasty and decompression of herniation.Electrocoagulation stimulation reaction,transient lower limb dysfunction(modified Bromage score),complications and manipulation time of anesthesia were compared between the two groups.Results There was no significant difference in general information between the two groups(all P>0.05).The NRS was significantly lower in the group lateral recess(1.7±0.9)than that in the group local anesthesia(3.5+1.0)during the process of foraminoplasty(t=7.49,P<0.001).However,there was no significant difference of NRS during the process of decompression of herniation(t=1.30,P=0.198).There were also no significant differences in electrocoagulation stimulation reaction,modified Bromage score,complications and manipulation time of anesthesia between the two groups(all P>0.05).Conclusion Single unilateral epidural blockade via lateral recess approach can provide better pain management than local anesthesia during percutaneous endoscopic lumbar discectomy for the treatment of patients with lumbar disc herniation.

关 键 词：椎间盘切除术 经皮 疼痛控制 侧隐窝 腰椎间盘突出症 

分 类 号：R614[医药卫生—麻醉学]