Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
Spine (Phila Pa 1976). 2011 Dec 1;36(25):2224-31. doi: 10.1097/BRS.0b013e318205e3d7.
Retrospective, nonrandomized, comparative study.
This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with three methods of pain control after posterior lumbar spinal surgery.
The use of opioids for postoperative pain control is common after spinal surgery; however, PONV is the most frequently encountered side effect, and it is yet to be overcome. The effectiveness of the use of an absorbable low-dose morphine-soaked microfibrillar collagen hemostatic sponge placed on the surface of the dural sac (epidural MMCHS) was compared to patient-controlled analgesia (PCA) and intermittent intramuscular bolus injection of meperidine for postoperative pain control after spine surgery.
One hundred sixty-five patients who underwent short-segment posterior lumbar spinal decompression and fusion surgery between January 2007 and July 2007 in the orthopedic department of a medical center were enrolled. For postoperative pain control, 40 patients received epidural MMCHS, 48 patients received PCA, and 77 patients received meperidine injection. Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded at 4 hours postoperation and on postoperative days 1, 2, and 3.
The analgesic effect was enhanced significantly in both epidural MMCHS group and the PCA group as compared with the meperidine group on postoperative days 1 and 2 (P < 0.05). On postoperative days 1, 2, and 3, PONV was more severe in the PCA group than in the other two groups (P < 0.05). The side effects of epidural MMCHS were nausea (25%), pruritus (12.5%), vomiting (5%), and hypotension (2.5%).
A single low-dose epidural MMCHS is effective for postoperative pain control and minimizes the occurrence of PONV after posterior lumbar spinal surgery.
回顾性、非随机、对照研究。
本研究比较了三种不同方法在腰椎后路手术后的早期镇痛效果和术后恶心呕吐（PONV）相关情况。
术后疼痛控制中使用阿片类药物较为常见，但 PONV 是最常见的不良反应，目前尚未克服。本研究比较了在硬脊膜表面放置可吸收低剂量吗啡浸渍微纤维胶原止血海绵（硬膜外 MMCHS）、患者自控镇痛（PCA）和间断肌内注射哌替啶用于脊柱手术后的镇痛效果。
2007 年 1 月至 2007 年 7 月期间，骨科中心共收治了 165 例短节段腰椎后路减压融合术患者。术后镇痛方面，40 例患者使用硬膜外 MMCHS，48 例患者接受 PCA，77 例患者接受哌替啶注射。患者术后 4 小时和第 1、2、3 天记录疼痛强度（视觉模拟评分 0-10 分）、恶心（0-5 分）和呕吐（0-5 分）。
与哌替啶组相比，硬膜外 MMCHS 组和 PCA 组在术后第 1、2 天的镇痛效果明显增强（P < 0.05）。在术后第 1、2 和 3 天，PCA 组的 PONV 比其他两组更严重（P < 0.05）。硬膜外 MMCHS 的副作用包括恶心（25%）、瘙痒（12.5%）、呕吐（5%）和低血压（2.5%）。
单次硬膜外低剂量 MMCHS 可有效控制腰椎后路手术后的疼痛，并最大程度减少 PONV 的发生。
