Choi Eun Joo, Yoo Yong Jae, Lee Pyung Bok, Kim Yong-Chul, Lee Sang Chul, Moon Jee Youn
From the *Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital College of Medicine, Sungnam-si, Gyonggi-do, Republic of Korea; and †Integrated Cancer Management Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea.
Anesth Analg. 2017 Jun;124(6):2021-2029. doi: 10.1213/ANE.0000000000001925.
Percutaneous epidural adhesiolysis (PEA) is a minimally invasive procedure that is performed to relieve low back and/or lower limb pain secondary to adhesions or scarring in the epidural space that is refractory to conservative treatment. The optimal concentration of hypertonic saline might be an important factor in the safety and efficacy of PEA. We evaluated differences in the efficacy and safety of 2 concentrations of hypertonic saline (5% and 10%) used in lumbar PEA at our institutions in a retrospective study.
Patients who received lumbar PEA between January 2009 and June 2014 at either of 2 large civilian teaching institutions in South Korea were assigned to the 5% or 10% groups according to the osmolality of saline. The primary outcome of this study was the difference in change in the 11-point numerical rating scale (NRS) scores of low back and leg pain from baseline to 6 months after PEA between patients in the 2 groups. The number of additional epidural injections, patients' satisfaction with PEA, and any complications that occurred within 6 months after PEA were reviewed.
This study included 543 patients (5% group, 333; 10% group, 210). Post-PEA NRS pain scores were significantly lower compared with those at baseline in both groups; however, there were no significant differences between the 2 groups at 6 months or any time point after PEA with regard to any of the clinical characteristics, except infusion-related pain, which exhibited borderline significance for greater scores in the 10% group compared with those in the 5% group (P = .041). Multivariable linear regression analysis with adjustments for covariates, including the number of additional epidural injections, revealed no significant association between patient group and the decrease in NRS pain scores at 6 months of follow-up. Transient adverse events related to PEA were recorded in 3 patients (10% group, 2; 5% group, 1).
In PEA, 5% hypertonic saline exhibited similar positive outcomes after 6 months of follow-up as 10% hypertonic saline, with less infusion-related pain. This result suggests that infusion of 5% hypertonic saline may be considered as an alternative to 10% hypertonic saline in lumbar PEA. Further prospective randomized studies are required to better appreciate the outcome with regard to the use of different concentrations of hypertonic saline for PEA.
经皮硬膜外粘连松解术（PEA）是一种微创手术，用于缓解因硬膜外腔粘连或瘢痕形成导致的腰背部和/或下肢疼痛，这些疼痛对保守治疗无效。高渗盐水的最佳浓度可能是PEA安全性和有效性的一个重要因素。我们通过一项回顾性研究评估了在我们机构中用于腰椎PEA的两种浓度高渗盐水（5%和10%）在疗效和安全性上的差异。
2009年1月至2014年6月期间在韩国两家大型民用教学机构之一接受腰椎PEA的患者，根据盐水的渗透压被分为5%或10%组。本研究的主要结局是两组患者从基线到PEA后6个月腰背部和腿部疼痛的11点数字评定量表（NRS）评分变化的差异。回顾了额外硬膜外注射的次数、患者对PEA的满意度以及PEA后6个月内发生的任何并发症。
本研究纳入了543例患者（5%组333例；10%组210例）。两组患者PEA后的NRS疼痛评分均显著低于基线水平；然而，在PEA后6个月或任何时间点，两组在任何临床特征方面均无显著差异，但与输注相关的疼痛除外，10%组的评分高于5%组，具有临界显著性（P = 0.041）。对包括额外硬膜外注射次数在内的协变量进行调整的多变量线性回归分析显示，患者分组与随访6个月时NRS疼痛评分的降低之间无显著关联。3例患者记录了与PEA相关的短暂不良事件（10%组2例；5%组1例）。
在PEA中，5%高渗盐水在随访6个月时显示出与10%高渗盐水相似的积极结果，且输注相关疼痛更少。这一结果表明，在腰椎PEA中，5%高渗盐水的输注可被视为10%高渗盐水的替代方法。需要进一步的前瞻性随机研究，以更好地了解使用不同浓度高渗盐水进行PEA的结果。
