Surange Pankaj N, Venkata Rama Mohan Brig Chadalavada
Interventional Pain and Spine Centre, New Delhi, India.
Armed Forces Medical College, Pune, India.
Anesth Pain Med. 2012 Winter;1(3):178-83. doi: 10.5812/kowsar.22287523.3348. Epub 2012 Jan 1.
Effective control of postoperative pain remains one of the most important and pressing issues in the field of surgery and has a significant impact on our health care system. In too many patients, pain is treated inadequately, causing them needless suffering and they can develop complications as an indirect consequence of pain. Analgesic modalities, if properly applied, can prevent or at least minimize this needless suffering and these complications.
The aim of this study was to compare the efficacy of continuous infusions of local anesthetic drugs by paravertebral and epidural routes in controlling postoperative pain in patients undergoing hip surgeries.
The study involved 60 patients who were undergoing hip surgery under the subarachnoid block. They were randomly divided into 2 groups of 30 patients. Group I (paravertebral group) received a single dose of spinal anesthesia with 2.5 mL 0.5% bupivacaine (heavy) + a continuous infusion of 0.125% bupivacaine at 5 mL/h in the paravertebral space. Group II (epidural group) received a single dose of spinal anesthesia with 0.5% bupivacaine (heavy) + a continuous infusion of 0.125% bupivacaine at a rate of 5 mL/hr in the epidural space for 48 hours in the postoperative period. Visual analogue scale (VAS) score, vital statistics, rescue analgesia, and procedure time were compared with the corresponding times between the 2 groups by student's t-test and repeated measures ANOVA with post hoc Bonferroni. P < 0.05 was considered significant. There were no statistically significant differences between the 2 groups regarding mean pain score in the first 48 hours.
Mean arterial pressure was significantly lower in the epidural group compared with the paravertebral group from 2 hours after start of the infusion until 48 hrs. Regional anesthesia procedure time was significantly longer in the epidural group (P < 0.001). There was no significant difference between the 2 groups regarding frequency of postoperative complications and catheter-related problems.
The results of our study indicate that for patients who are scheduled for hip surgery, both continuous paravertebral and continuous epidural analgesia are effective in controlling postoperative pain but that the former has several crucial advantages.
有效控制术后疼痛仍然是外科领域最重要且紧迫的问题之一，对我们的医疗保健系统有重大影响。在太多患者中，疼痛未得到充分治疗，给他们带来不必要的痛苦，并且他们可能因疼痛间接引发并发症。如果正确应用镇痛方式，可以预防或至少将这种不必要的痛苦和这些并发症降至最低。
本研究的目的是比较经椎旁和硬膜外途径持续输注局部麻醉药物在控制髋关节手术患者术后疼痛方面的疗效。
该研究纳入了60例接受蛛网膜下腔阻滞下髋关节手术的患者。他们被随机分为2组，每组30例患者。第一组（椎旁组）接受2.5 mL 0.5%布比卡因（重比重）单次剂量的脊麻 + 在椎旁间隙以5 mL/h持续输注0.125%布比卡因。第二组（硬膜外组）接受0.5%布比卡因（重比重）单次剂量的脊麻 + 在术后48小时内于硬膜外间隙以5 mL/hr的速率持续输注0.125%布比卡因。通过学生t检验以及重复测量方差分析和事后Bonferroni检验，将两组之间相应时间的视觉模拟量表（VAS）评分、生命体征、补救镇痛和手术时间进行了比较。P < 0.05被认为具有统计学意义。在最初48小时内，两组之间的平均疼痛评分无统计学显著差异。
从输注开始后2小时至48小时，硬膜外组的平均动脉压显著低于椎旁组。硬膜外组的区域麻醉手术时间显著更长（P < 0.001）。两组在术后并发症和导管相关问题的发生率方面无显著差异。
我们的研究结果表明，对于计划进行髋关节手术的患者，持续椎旁镇痛和持续硬膜外镇痛在控制术后疼痛方面均有效，但前者具有几个关键优势。
