颈椎前路减压融合术后多模式镇痛与患者自控镇痛的比较
Multimodal Versus Patient-Controlled Analgesia After an Anterior Cervical Decompression and Fusion.
作者信息
Bohl Daniel D, Louie Philip K, Shah Neal, Mayo Benjamin C, Ahn Junyoung, Kim Tae D, Massel Dustin H, Modi Krishna D, Long William W, Buvanendran Asokumar, Singh Kern
机构信息
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, IL.
出版信息
Spine (Phila Pa 1976). 2016 Jun;41(12):994-998. doi: 10.1097/BRS.0000000000001380.
STUDY DESIGN
Retrospective analysis of a prospectively maintained surgical registry.
OBJECTIVE
To compare postoperative narcotic consumption between multimodal analgesia (MMA) and patient-controlled analgesia (PCA) after an anterior cervical discectomy and fusion (ACDF).
SUMMARY OF BACKGROUND DATA
Studies suggest that a multimodal approach to pain management leads to decreased pain and morphine consumption after total joint arthroplasty and lumbar spinal procedures. Patients and surgeons would benefit from knowing whether a multimodal approach to pain management is superior to PCA for ACDF.
METHODS
A retrospective cohort study of ACDF patients receiving either MMA or PCA was conducted. Inpatient narcotic consumption, pain scores, nausea/vomiting, hospital length of stay, and narcotic dependence during the months after surgery were compared between MMA and PCA.
RESULTS
A total of 239 patients met inclusion criteria. Of these, 55 (23.0%) received MMA and 184 (77.0%) received PCA. Patients who received MMA had a lower rate of inpatient narcotic consumption (2.5 OME/h vs. 5.8 OME/h, P < 0.001) were less likely to experience nausea/vomiting during the hospitalization (5.5% vs. 37.5%, P < 0.001), and had a shorter hospital length of stay (27.3 vs. 40.1 h, P < 0.001). However, there was no difference between groups in mean visual analogue pain scale during postoperative day zero (4.7 for MMA vs. 5.2 for PCA, P = 0.126) or during postoperative day one (4.1 for MMA vs. 4.1 for PCA, P = 0.937). In addition, there was no difference in the rate of narcotic dependence at the first (P = 0.626) or second (P = 0.480) postoperative visits.
CONCLUSION
These data suggest that MMA results in lower narcotic consumption than PCA after an ACDF. This difference is associated with a shorter inpatient stay and a decrease in postoperative nausea/vomiting. Critically, MMA and PCA appear to provide similar postoperative analgesia.
LEVEL OF EVIDENCE
研究设计
对前瞻性维护的手术登记册进行回顾性分析。
目的
比较前路颈椎间盘切除融合术（ACDF）后多模式镇痛（MMA）与患者自控镇痛（PCA）的术后麻醉药物消耗量。
背景数据总结
研究表明，多模式疼痛管理方法可减少全关节置换术和腰椎手术术后的疼痛及吗啡消耗量。了解多模式疼痛管理方法对于ACDF是否优于PCA将使患者和外科医生受益。
方法
对接受MMA或PCA的ACDF患者进行回顾性队列研究。比较MMA组和PCA组患者术后住院期间的麻醉药物消耗量、疼痛评分、恶心/呕吐情况、住院时间以及麻醉药物依赖情况。
结果
共有239例患者符合纳入标准。其中，55例（23.0%）接受MMA，184例（77.0%）接受PCA。接受MMA的患者住院期间麻醉药物消耗量较低（2.5 OME/h对5.8 OME/h，P < 0.001），住院期间发生恶心/呕吐的可能性较小（5.5%对37.5%，P < 0.001），住院时间较短（27.3小时对40.1小时，P < 0.001）。然而，术后第0天（MMA组为4.7，PCA组为5.2，P = 0.126）或术后第1天（MMA组为4.1，PCA组为4.1，P = 0.937）两组的平均视觉模拟疼痛量表评分无差异。此外，术后首次（P = 0.626）或第二次（P = 0.480）随访时的麻醉药物依赖率也无差异。
结论
这些数据表明，ACDF术后MMA的麻醉药物消耗量低于PCA。这种差异与较短的住院时间和术后恶心/呕吐的减少有关。关键的是，MMA和PCA似乎提供相似的术后镇痛效果。
证据级别
3级。
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