Attari Moahammad A, Najafabadi Fereidoun Mortazavi, Talakoob Reyhanak, Abrishamkar Saeid, Taravati Hosein
Departments of *Anesthesiology†Neuroanesthesia‡Neurosurgery, Alzahra Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan§Department of Anesthesiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
J Neurosurg Anesthesiol. 2016 Jan;28(1):38-43. doi: 10.1097/ANA.0000000000000232.
The aim of this study was to investigate the effects of adding intrathecal (IT) fentanyl and magnesium sulfate (MgSO4) to bupivacaine on sensory motor blocks and postoperative pain in patients undergoing lumbar disk herniation surgery.
In a double-blind randomized clinical trial, the patients undergoing lumbar disk herniation surgery were allocated to receive hyperbaric bupivacaine (A), or hyperbaric bupivacaine and fentanyl (B), hyperbaric bupivacaine, fentanyl and MgSO4 (C) IT. Data were collected regarding the onset of sensory block and time to regression to T10, time to complete motor block and full motor recovery, time to first analgesic requirement, postoperative pain score, and analgesic consumption and side effects. P<0.05 was considered to be statistically significant.
A total of 105 patients were randomized and assigned to 3 groups (n=35 in each groups). There were no significant differences between groups in regard to time to reach the T10 level of sensory block (P=0.82), time to regression to T10 (P=0.11), and the time to complete motor block (P=0.58). Meanwhile, the time to complete recovery of motor function was significantly longer in group C (116.4±18.4, 126.4±25.5, 130.2±15.7 min, respectively, P=0.016). Time to first analgesic requirement was also significantly longer in group C (3.26±1.12, 5.57±0.92, 6.91±1.27 h, respectively, P<0.001). Total morphine consumption was significantly less in group C (14.3±4.3, 8.3±3.5, 6±3.6 mg, respectively, P<0.001). The severity of pain was significantly less in C group (P<0.001).
In patients undergoing lumbar disk herniation surgery, IT MgSO4 in combination with bupivacaine-fentanyl can decrease severity of postoperative pain and analgesic consumption without additional side effect.
本研究旨在探讨在布比卡因中加入鞘内注射（IT）芬太尼和硫酸镁（MgSO4）对腰椎间盘突出症手术患者感觉运动阻滞及术后疼痛的影响。
在一项双盲随机临床试验中，将接受腰椎间盘突出症手术的患者分为三组，分别接受高压布比卡因（A组）、高压布比卡因加芬太尼（B组）、高压布比卡因加芬太尼和MgSO4（C组）鞘内注射。收集感觉阻滞起效时间、恢复至T10水平的时间、运动阻滞完全起效时间及完全恢复时间、首次需要镇痛的时间、术后疼痛评分、镇痛药物消耗量及副作用等数据。P<0.05被认为具有统计学意义。
共105例患者随机分为3组（每组n = 35）。三组在达到T10感觉阻滞水平的时间（P = 0.82）、恢复至T10的时间（P = 0.11）和运动阻滞完全起效时间（P = 0.58）方面无显著差异。同时，C组运动功能完全恢复的时间明显更长（分别为116.4±18.4、126.4±25.5、130.2±15.7分钟，P = 0.016）。C组首次需要镇痛的时间也明显更长（分别为3.26±1.12、5.57±0.92、6.91±1.27小时，P<0.001）。C组吗啡总消耗量明显更少（分别为14.3±4.3、8.3±3.5、6±3.6毫克，P<0.001）。C组疼痛严重程度明显更低（P<0.001）。
在接受腰椎间盘突出症手术的患者中，鞘内注射MgSO4联合布比卡因 - 芬太尼可降低术后疼痛严重程度及镇痛药物消耗量，且无额外副作用。
