摘要
目的比较罗哌卡因持续切口浸润(CWI)、竖脊肌平面阻滞(ESPB)或患者自控镇痛(PCA)用于青少年特发性脊柱侧凸(AIS)术后镇痛的效果。方法选择2019年12月—2020年8月由海军军医大学第二附属医院收治,明确诊断为AIS需行手术治疗的患者60例,根据采用的镇痛技术,按照1∶1∶1的比例将患者随机分配至PCA组、CWI组及ESPB组,每组20例。PCA组术后给予常规PCA镇痛;CWI组于术毕前给予双侧切口内各浸润注射0.375%罗哌卡因10 mL,并放置导管连续输注0.2%罗哌卡因48 h,术后予PCA;ESPB组于切皮前实施双侧单次ESPB,每侧给予0.375%罗哌卡因20 mL,术后予PCA。记录于术后2、4、6、8、12、24、48、72 h时疼痛VAS评分,以及术中总舒芬太尼用量、术后48 h内PCA泵中舒芬太尼用量、补救镇痛率、不良反应、胃肠功能恢复时间。结果术后2、4、6 h时,CWI组和ESPB组的疼痛VAS评分均显著低于PCA组同时间(P值均<0.05);术后8、12、24 h时,ESPB组的疼痛VAS评分均显著高于CWI组和PCA组同时间(P值均<0.05);术后48、72 h,3组间疼痛VAS评分的差异均无统计学意义(P值均>0.05)。PCA组、CWI组、ESPB组术中总舒芬太尼用量分别为(54.1±13.4)、(55.5±7.9)、(41.1±5.8)μg,ESPB组术中总舒芬太尼用量显著少于PCA组和CWI组(P<0.001)。术后48 h内PCA泵中舒芬太尼用量分别为(60.3±25.7)、(16.0±14.4)、(25.0±16.1)μg,PCA组显著多于ESPB组及CWI组(P=0.021)。PCA组、CWI组、ESPB组补救镇痛率分别为30%(6/20)、10%(2/20)、20%(4/20),3组间的差异无统计学意义(P>0.05)。PCA组、CWI组、ESPB组术后恶心呕吐发生率分别为30%(6/20)、0和5%(1/20),3组间的差异有统计学意义(P=0.013)。PCA组、CWI组、ESPB组术后胃肠功能恢复时间分别为(45.6±17.2)、(44.4±19.0)、(33.6±15.4)h,ESPB组胃肠功能恢复时间短于PCA组和CWI组(P=0.049)。结论CWI和ESPB均可显著改善AIS术后疼痛,并能减少阿片类药物相关不良反应的发生。
Objective To compare the analgesic effects of continuous wound infiltration(CWI),erector spinae plane block(ESPB)and patient-controlled analgesia(PCA)in postoperative pain management of adolescent idiopathic scoliosis(AIS)through a single-center randomized controlled trial.Methods A total of 60 AIS patients admitted to the Second Affiliated Hospital of Naval Medical University between December 2019 and August 2020 were randomly equally divided into PCA group,CWI group and ESPB group(n=20).PCA was applied in all the patients after surgery.Moreover,10 mL of 0.375%ropivacaine was infiltrated into the bilateral incisions and 0.2%ropivacaine was continuously infused for 48 h before suture in the CWI group;a bilateral ESPB was performed before incision and 20 mL of 0.375%ropivacaine was injected into each side in the ESPB group.Visual analogue scale(VAS)score was recorded at 2,4,6,8,12,24,48,72 h postoperatively.The intraoperative sufentanil consumption,total consumption of sufentanil within 48 h after surgery,rescue analgesia,adverse reaction,and recovery time of gastrointestinal function were also recorded.Results VAS score of CWI group and ESPB group were significantly lower than that of PCA group 2 h,4 h and 6 h postoperatively(all P<0.05).VAS score of ESPB group was significantly higher than that of CWI group and PCA group 8 h,12 h and 24 h postoperatively(all P<0.05).There was no significant difference in the VAS score between groups 48 h and 72 h postoperatively(both P>0.05).Intraoperative sufentanil consumption in ESPB group was significantly lower than that in PCA group and CWI group([41.1±5.8],[54.1±13.4],and[55.5±7.9]μg,P<0.001).PCA group used more sufentanil than ESPB group and CWI group within 48 h after surgery([60.3±25.7],[16.0±14.4],and[25.0±16.1]μg,P=0.021).The rescue analgesia rate was 30%(6/20)in PCA group,10%(2/20)in CWI group and 20%(4/20)in ESPB group(P>0.05).The incidence of postoperative nausea and vomiting was 30%(6/20),0 and 5%(1/20)in the three groups,respectively(P=0.013).The recover
作者
黄政康
书伦
李振杰
袁红斌
HUANG Zhengkang;SHU Lun;LI Zhenjie;YUAN Hongbin(不详;Department of Anesthesiology,Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)
出处
《上海医学》
CAS
2022年第7期482-486,共5页
Shanghai Medical Journal
基金
上海长征医院“金字塔人才工程”计划。
关键词
青少年特发性脊柱侧凸
持续切口浸润
竖脊肌平面阻滞
患者自控镇痛
Adolescent idiopathic scoliosis
Continuous wound infiltration
Erector spinae plane block
Patient-controlled analgesia
