鞘内注射吗啡和口服镇痛药可安全有效地控制青少年特发性脊柱侧凸后路脊柱融合术后的疼痛。

Intrathecal Morphine and Oral Analgesics Provide Safe and Effective Pain Control After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

机构信息

Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.

Division of Pediatric Anesthesiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.

出版信息

Spine (Phila Pa 1976). 2018 Jan 15;43(2):E98-E104. doi: 10.1097/BRS.0000000000002245.

DOI:10.1097/BRS.0000000000002245

PMID:28538591

Abstract

STUDY DESIGN

Retrospective comparative study.

OBJECTIVE

The aim of this study was to demonstrate that intrathecal morphine (ITM) and oral analgesics provide effective pain control after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), and this protocol has a low complication rate so patients can be admitted to a general care floor.

SUMMARY OF BACKGROUND DATA

Previous studies have shown that ITM combined with intravenous patient-controlled analgesia or epidural infusion (EPI) provides effective pain control after PSF for AIS. Owing to concerns for respiratory depression, ITM patients were routinely admitted to the intensive care unit (ICU) postoperatively. There are little data on ITM combined with oral analgesics.

METHODS

We identified AIS patients aged 10 to 17 years who had undergone PSF. Twenty-eight patients who received ITM were matched to 28 patients who received a hydromorphone EPI. The ITM group received oral oxycodone starting at 16 hours postinjection. The EPI group received oxycodone after the epidural catheter was removed on postoperative day 2. Pain scores, adverse events, and length of stay were recorded.

RESULTS

A higher number of EPI patients received fentanyl (11 vs. 3, P = 0.014) in the post-anesthesia care unit (PACU). The ITM group had lower pain scores between PACU discharge and midnight (mean 2.9 vs. 4.2, P = 0.034). Pain scores were similar during the remaining postoperative periods. All ITM patients transitioned to oxycodone without intravenous opioids. Time to ambulation (19.9 vs. 26.5 hours, P = 0.010) and Foley catheter removal (21.3 vs. 41.9 hours, P < 0.001) were earlier in the ITM patients. Length of hospital stay was shorter in the ITM group (3.1 vs. 3.5 days, P = 0.043). Adverse events occurred at similar rates in both groups.

CONCLUSION

ITM and oral analgesics provide safe and effective pain control after PSF for AIS. Routine postoperative admission to the ICU is not necessary.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性对比研究。

目的

本研究旨在证明鞘内吗啡（ITM）和口服镇痛药在青少年特发性脊柱侧凸（AIS）后路脊柱融合术后能有效控制疼痛，且该方案并发症发生率低，患者可入住普通病房。

背景资料概要

先前的研究表明，ITM 联合静脉自控镇痛或硬膜外输注（EPI）可有效控制 AIS 后路脊柱融合术后的疼痛。由于担心呼吸抑制，ITM 患者术后常规入住重症监护病房（ICU）。有关 ITM 联合口服镇痛药的数据较少。

方法

我们纳入了 10 至 17 岁接受后路脊柱融合术的 AIS 患者。28 例接受 ITM 的患者与 28 例接受氢吗啡酮 EPI 的患者相匹配。ITM 组在注射后 16 小时开始口服羟考酮。EPI 组在术后第 2 天拔除硬膜外导管后给予羟考酮。记录疼痛评分、不良事件和住院时间。

结果

在麻醉后护理单元（PACU），EPI 组有更多的患者接受了芬太尼（11 例比 3 例，P=0.014）。ITM 组在 PACU 出院至午夜之间的疼痛评分较低（平均 2.9 比 4.2，P=0.034）。其余术后期间的疼痛评分相似。所有 ITM 患者均无需静脉用阿片类药物即可转为口服羟考酮。开始活动的时间（19.9 比 26.5 小时，P=0.010）和拔除 Foley 导管的时间（21.3 比 41.9 小时，P<0.001）在 ITM 组更早。ITM 组的住院时间更短（3.1 比 3.5 天，P=0.043）。两组的不良事件发生率相似。