经皮腰椎内窥镜下手术麻醉方案选择的前瞻性随机对照研究

Strategies of anesthesia in percutaneous endoscopic lumbar discectomy: a prospective randomized controlled trial

中文关键词:  经皮内窥镜下腰椎间盘切除术  麻醉  疼痛控制  随机对照研究

英文关键词:Percutaneous endoscopic lumbar discectomy(PELD)  Anesthesia  Pain control  randomized controlled trial

中文摘要:

  【摘要】 目的：探讨不同局部浸润麻醉方法对经皮腰椎内窥镜下手术中疼痛的控制效果。方法：2015年2月～2015年6月在我院因腰椎间盘突出症接受经皮内窥镜下腰椎间盘切除术（PELD）治疗的患者纳入本研究，随机分为两组：A组麻醉方法为浓度1%的利多卡因稀释溶液局部浸润麻醉；B组为在A组的基础上加入盐酸罗哌卡因注射液100mg局部浸润麻醉并在手术开始前静脉注射枸橼酸芬太尼注射液0.05mg及盐酸昂丹司琼注射液8mg。采用椎间孔成形期VAS评分、纤维环操作期VAS评分、术后即刻及术后24h再手术意愿评估术中疼痛控制效果。结果：共82例患者纳入研究，A组42例，B组40例。椎间孔成形期B组在平均疼痛VAS评分（1.1±0.9）及峰值疼痛VAS评分（1.3±0.9）上都显著低于A组（3.2±2.4及5.1±2.3）。纤维环相关操作期两组间平均疼痛VAS评分和峰值VAS评分无显著差异。B组术后即刻再手术意愿显著高于A组（95.0%∶71.4%），术后24h两组再手术意愿无显著差异（97.5%∶97.6%）。两组患者术后均未出现麻醉及手术相关并发症。结论：采用利多卡因及罗哌卡因混合局麻联合静脉芬太尼镇痛的麻醉方案在不增加手术风险的前提下可显著改善腰椎内镜手术术中疼痛控制。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of different local infiltration anesthesia on paincontrol with percutaneous endoscopic lumbar discectomy(PELD). Methods: From February 2015 to June 2015, patients treated with PELD due to lumbar disc herniation in our hospital were selected. Patients were randomly divided into two groups: group A, 1% lidocaine dilution solution; group B, ropivacaine hydrochloride injection 100mg on the basis of group A, with fentanyl citrate injection 0.05mg and ondansetron hydrochloride injection 8mg at pre-operation. The pain control effect was evaluated by VAS scores at the time of lumbar foraminoplasty and annulus fibrosus operation, and re-operation intention immediately after operation and 24 hours after operation. Results: A total of 82 patients were included in the study, 42 patients in group A, and 40 patients in group B. The average pain VAS score(1.1±0.9) and the peak pain VAS score(1.3±0.9) of group B were significantly lower at the time of lumbar foraminoplasty than those of group A(3.2±2.4, 5.1±2.3). There was no significant difference of VAS scores at the time of annulus fibrosus operation between two groups. Re-operation intention of group B was significantly higher than that of group A(95.0% vs 71.4%) immediately after operation, and there was no significant difference between two groups(97.5% vs 97.6%) 24 hours after operation. There were no anesthesia and surgery related complications in two groups． Conclusions: Local anesthesia by using lidocaine and ropivacaine, combined with intravenous fentanyl, can significantly improve the pain control in lumbar endoscopic surgery with no increase of surgical risk.