Li Zhuhai, Zeng Jiancheng, Nie Hongfei, Jiang Hushan, Xie Tianhang, Song Yueming
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Orthopedics, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi, 530021, P.R.China.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Feb 15;31(2):215-221. doi: 10.7507/1002-1892.201609084.
To investigate the effectiveness of combined Pregabalin and Celecoxib for neuropathic pain after percutaneous endoscopic lumbar discectomy.
Between January and June 2014, 178 patients with lumbar disc herniation underwent percutaneous endoscopic interlaminar discectomy (PEID). Ninety patients who met the inclusion criteria were recruited in this study. Every case in group A was recruited to match its counterpart in group B and group C according to gender, disease duration, herniated level, smoking history, preoperative Leeds assessment of neuropathic symptoms and signs (LANSS), and Oswestry disability index (ODI). Nine patients were excluded due to incomplete study or loss of follow-up. In each group, 27 cases were included in the final analysis. There was no significant difference in gender, age, height, body mass index, herniated level, disease duration, smoking history, preoperative LANSS, ODI, and visual analogue scale (VAS) between groups ( >0.05). All patients of 3 groups received oral administration of Celecoxib from preoperative 3rd day to postoperative 14th day. Pregabalin was taken orally from preoperative 3rd day to postoperative 14th day in group A, and from postoperative 1st to 14th day in group B. Adverse drug reactions were observed during medication. The LANSS score and VAS score in rest state and active state were conducted before operation and at 1 day, 1 month, and 3 months after operation. ODI was conducted before operation and at 1, 3 months after operation. The number of neuropathic pain cases was recorded, and the effectiveness was evaluated by modified Macnab criteria at 3 months after operation.
During period of increasing Pregabalin dose, 1 patient of group A suffered severe dizziness, and 1 patient of group B suffered sleepiness, who were eliminated from this research. Another 2 cases (1 case of group A and 1 case of group C) suffered dry mouth, and 1 case of group B suffered muscle weakness. At 1 day after operation, the LANSS score and VAS in rest state and active state of group A were significantly lower than those of groups B and C ( <0.05). At 1 month after operation, the LANSS score, ODI, and VAS in rest state and active state of group A and group B were significantly lower than those of group C ( <0.05). At 3 months after operation, the LANSS score, ODI, and VAS in active state of group A and group B were significantly lower than those of group C ( <0.05). There was no significant difference in the above indicators at the other time points between groups ( >0.05). Neuropathic pain occurred at 3 months after operation in 1 case (3.7%) of group A and 6 cases (22.2%) of group C, showing significant differences in incidence of neuropathy pain between groups A, B and group C ( <0.05), but no significant difference was found between group A and group B ( >0.05). The excellent and good rate of modified Macnab criteria was 92.6% in group A, was 88.9% in group B, and was 85.2% in group C at 3 months after operation, showing no significant difference between groups ( >0.05).
Combined use of Pregabalin and Celecoxib during perioperative period can reduce postoperative pain and incidence of postoperative neuropathic pain. Preoperative oral Pregabalin can reduce the incidence of acute postoperative neuropathic pain.
探讨普瑞巴林与塞来昔布联合应用于经皮内镜下腰椎间盘摘除术后神经性疼痛的疗效。
2014年1月至6月，178例腰椎间盘突出症患者接受了经皮内镜下椎间孔入路椎间盘切除术（PEID）。本研究纳入了90例符合纳入标准的患者。根据性别、病程、突出节段、吸烟史、术前利兹神经病理性症状和体征评估（LANSS）以及Oswestry功能障碍指数（ODI），将A组的每例患者与B组和C组的对应患者进行匹配。9例患者因研究不完整或失访而被排除。每组最终纳入分析27例。三组患者在性别、年龄、身高、体重指数、突出节段、病程、吸烟史、术前LANSS、ODI和视觉模拟评分（VAS）方面差异无统计学意义（P>0.05）。三组所有患者均于术前第3天至术后第14天口服塞来昔布。A组患者于术前第3天至术后第14天口服普瑞巴林，B组患者于术后第1天至第14天口服普瑞巴林。用药期间观察药物不良反应。于术前及术后1天、1个月和3个月进行静息状态和活动状态下的LANSS评分及VAS评分。术前及术后1、3个月进行ODI评估。记录神经性疼痛病例数，并于术后3个月采用改良Macnab标准评估疗效。
在增加普瑞巴林剂量期间，A组1例患者出现严重头晕，B组1例患者出现嗜睡，均退出本研究。另外2例（A组1例、C组1例）出现口干，B组1例出现肌无力。术后1天，A组静息状态和活动状态下的LANSS评分及VAS评分均显著低于B组和C组（P<0.05）。术后1个月，A组和B组的LANSS评分、ODI及静息状态和活动状态下的VAS评分均显著低于C组（P<0.05）。术后3个月，A组和B组活动状态下的LANSS评分、ODI及VAS评分均显著低于C组（P<0.05）。三组在其他时间点上述指标差异无统计学意义（P>0.05）。术后3个月，A组1例（3.7%）、C组6例（22.2%）发生神经性疼痛，A、B、C三组神经性疼痛发生率差异有统计学意义（P<0.05），但A组与B组之间差异无统计学意义（P>0.05）。术后3个月，A组改良Macnab标准优良率为92.6%，B组为88.9%，C组为85.2%，三组之间差异无统计学意义（P>0.05）。
围手术期联合应用普瑞巴林和塞来昔布可减轻术后疼痛及术后神经性疼痛的发生率。术前口服普瑞巴林可降低术后急性神经性疼痛的发生率。
