Seki Hiroyuki, Ideno Satoshi, Ishihara Taiga, Watanabe Kota, Matsumoto Morio, Morisaki Hiroshi
1Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582 Japan.
2Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582 Japan.
Scoliosis Spinal Disord. 2018 Sep 12;13:17. doi: 10.1186/s13013-018-0165-z. eCollection 2018.
Posterior spinal fusion for adolescent idiopathic scoliosis is one of the most invasive surgical procedures performed in children and adolescents. Because of the extensive surgical incision and massive tissue trauma, posterior spinal fusion causes severe postoperative pain. Intravenous patient-controlled analgesia with opioids has been the mainstay of postoperative pain management in these patients. However, the use of systemic opioids is sometimes limited by opioid-related side effects, resulting in poor analgesia. To improve pain management while reducing opioid consumption and opioid-related complications, concurrent use of analgesics and analgesic modalities with different mechanisms of action seems to be rational. The efficacy of intrathecal opioids and nonsteroidal anti-inflammatory drugs as components of multimodal analgesia in scoliosis surgery has been well established. However, there is either controversy or insufficient evidence regarding the use of other analgesic methods, such as continuous ketamine infusion, perioperative oral gabapentin, acetaminophen, continuous wound infiltration of local anesthetics, a single dose of systemic dexamethasone, and lidocaine infusion in this patient population. Moreover, appropriate combinations of analgesics have not been established. The aim of this literature review is to provide detailed information of each analgesic technique so that clinicians can make appropriate choices regarding pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.
青少年特发性脊柱侧凸后路脊柱融合术是儿童和青少年中最具侵入性的外科手术之一。由于手术切口广泛且组织创伤巨大，后路脊柱融合术会导致严重的术后疼痛。静脉自控镇痛联合阿片类药物一直是这些患者术后疼痛管理的主要方法。然而，全身性阿片类药物的使用有时会受到阿片类药物相关副作用的限制，导致镇痛效果不佳。为了在减少阿片类药物消耗和阿片类药物相关并发症的同时改善疼痛管理，联合使用作用机制不同的镇痛药和镇痛方式似乎是合理的。鞘内注射阿片类药物和非甾体类抗炎药作为多模式镇痛的组成部分在脊柱侧凸手术中的疗效已得到充分证实。然而，对于其他镇痛方法的使用，如持续输注氯胺酮、围手术期口服加巴喷丁、对乙酰氨基酚、持续伤口浸润局部麻醉药、单次剂量全身性地塞米松以及在该患者群体中输注利多卡因，存在争议或证据不足。此外，尚未确定镇痛药的合适组合。这篇文献综述的目的是提供每种镇痛技术的详细信息，以便临床医生能够对接受后路脊柱融合术的青少年特发性脊柱侧凸患者的疼痛管理做出合适的选择。
