Singh Anshuman, Jindal Parul, Khurana Gurjeet, Kumar Ranjeet
Department of Anesthesia, HIMS, SRHU, Dehradun, Uttarakhand, India.
Department of Neurosurgery, HIMS, SRHU, Dehradun, Uttarakhand, India.
Indian J Anaesth. 2017 Jul;61(7):562-569. doi: 10.4103/ija.IJA_684_16.
Very few studies have compared continuous wound infiltration (CWI), continuous epidural infusion (CEI) and intravenous Patient Controlled Analgesia (PCA) with morphine in spine surgery. This study compared these modalities in patients undergoing microdissectomy.
This prospective, randomized control trial was conducted on 75 patients of American Society of Anesthesiologists' physical status I or II undergoing microdiscectomy. Patients in all the three groups received morphine 1 mg IV, with a lockout period of 10 min after each bolus, and the maximum allowed dose was 15 mg/5 h postoperatively. Patients in Group A received CWI with 0.25% levobupivacaine 20 mL as bolus after extubation followed by infusion at 5 mL/h. Group B received CEI with 0.25% levobupivacaine at 5 mL/h. Patients in Group C received intravenous (IV) morphine by PCA pump only. The primary end points were static and dynamic visual analogue scores (VAS) and postoperative pain scores. Secondary observations were postoperative morphine consumption at 8 h, 24 h and 48 h, and patient satisfaction.
Group A showed greater analgesic effects at 12 h ( < 0.02), 24 h ( < 0.03), 36 h ( < 0.008) and 48 h ( < 0.007) when compared to the other two techniques, as pain scores were less in group A as compared to group B and C. The requirement of postoperative intravenous morphine (mg) was 18 ± 12.82, 22.92 ± 9.88, 41.56 ± 8.83 for groups A, B and C after 48 h ( < 0.001).
Continuous wound infiltration is an effective postoperative pain control technique with minimal side effects, after spinal surgery.
很少有研究比较脊柱手术中持续伤口浸润（CWI）、持续硬膜外输注（CEI）和静脉自控镇痛（PCA）联合吗啡的效果。本研究比较了这些方法在接受显微椎间盘切除术患者中的应用。
本前瞻性随机对照试验纳入了75例美国麻醉医师协会身体状况I或II级、接受显微椎间盘切除术的患者。三组患者均静脉注射1mg吗啡，每次推注后锁定时间为10分钟，术后最大允许剂量为15mg/5小时。A组患者拔管后以20mL推注0.25%左旋布比卡因进行持续伤口浸润，随后以5mL/h的速度输注。B组患者以5mL/h的速度接受0.25%左旋布比卡因持续硬膜外输注。C组患者仅通过PCA泵静脉注射吗啡。主要终点是静态和动态视觉模拟评分（VAS）以及术后疼痛评分。次要观察指标是术后8小时、24小时和48小时的吗啡消耗量以及患者满意度。
与其他两种技术相比，A组在12小时（P<0.02）、24小时（P<0.03）、36小时（P<0.008）和48小时（P<0.007）时镇痛效果更佳，因为A组的疼痛评分低于B组和C组。48小时后，A、B、C组术后静脉注射吗啡的需求量（mg）分别为18±12.82、22.92±9.88、41.56±8.83（P<0.001）。
持续伤口浸润是脊柱手术后一种有效的术后疼痛控制技术，副作用最小。
