Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Neurosurgery. 2010 Mar;66(3 Suppl Operative):99-106; discussion 106-7. doi: 10.1227/01.NEU.0000349208.87863.B3.
Patients who undergo posterior cervical spinal fusion procedures frequently experience significant postoperative pain. Use of a local anesthetic continuous infusion pump after surgery may improve these outcome variables.
After posterior cervical spine fusion procedures, 25 consecutive patients received continuous infusion of 0.5% bupivacaine into the subfascial aspects of the wound via an elastomeric pump. Data were collected prospectively by third party assessment using standard nursing protocols. This included numeric pain scores and opiate use over the first 4 postoperative days (PODs), length of hospitalization, and complications. In a retrospective analysis, we compared each study patient to a control patient who did not receive the continuous infusion of bupivacaine. Demographic variables and surgical procedure were similar among matched cases.
Patients receiving continuous local anesthetic infusion used significantly less narcotics (P < .05) during the first 4 PODs: 24.4% on day 1, 34.1% on day 2, 53.5% on day 3, and 58.1% on day 4. A lower average pain score was observed among study patients on each POD (P < .05): 31.5% less on day 1, 13.0% on day 2, 24.0% on day 3, and 35.7% on day 4. Patients with the infusion device were discharged home earlier (POD 4.9 versus 6.7; P = .024) and demonstrated improvement in time to ambulation, first bowel movement, and discontinuation of the patient-controlled analgesia machine. No complications were associated with the device.
Patients with the local anesthetic continuous infusion device required less narcotics and reported lower pain scores than control patients on each of the first 4 PODs. These results suggest that continuous infusion of local anesthetic into the paravertebral tissue during the immediate postoperative period is a safe and effective technique that achieves lower pain scores and narcotic use and improves multiple postoperative outcome variables.
接受后路颈椎融合术的患者常经历显著的术后疼痛。手术后使用局部麻醉持续输注泵可能会改善这些结果变量。
后路颈椎融合术后，25 例连续患者通过弹性泵将 0.5%布比卡因持续输注到筋膜下伤口。通过第三方使用标准护理方案进行前瞻性数据收集。这包括在术后第 4 天（POD）内的数字疼痛评分和阿片类药物使用、住院时间和并发症。在回顾性分析中，我们将每个研究患者与未接受布比卡因持续输注的对照患者进行比较。匹配病例的人口统计学变量和手术程序相似。
接受连续局部麻醉输注的患者在第 1 至 4 个 POD 期间使用的阿片类药物明显减少（P<.05）：第 1 天 24.4%，第 2 天 34.1%，第 3 天 53.5%，第 4 天 58.1%。研究患者在每个 POD 的平均疼痛评分较低（P<.05）：第 1 天少 31.5%，第 2 天少 13.0%，第 3 天少 24.0%，第 4 天少 35.7%。带输注装置的患者更早出院（POD 4.9 与 6.7；P=.024），并且在行走、首次排便和停止患者自控镇痛机方面有所改善。该装置没有并发症。
与对照组患者相比，在术后第 1 至 4 天，接受局部麻醉持续输注装置的患者需要更少的阿片类药物，且疼痛评分更低。这些结果表明，在术后即刻将局部麻醉剂持续输注到椎旁组织是一种安全有效的技术，可降低疼痛评分和阿片类药物使用，并改善多个术后结果变量。
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