Williams Mark G, Rigney Brian, Wafai Ahmad, Walder Andrew
Trauma and Orthopaedic Department, North Devon District Hospital, Barnstaple, UK.
J Spine Surg. 2019 Jun;5(2):245-250. doi: 10.21037/jss.2019.05.01.
Open lumbar spine surgery typically results in significant post-operative pain. Most pain protocols promote a multimodal approach aiming to reduce opiate requirements. This case-matched, prospective clinical study aims to establish the efficacy of dorsal ramus nerve root (DRN) blocks for post-operative analgesia.
We conducted a case-control observational, single centre, prospective study of 15 consecutive patients who had DRN block for a single-level lumbar discectomy or one/two-level lumbar spinal decompression, from Jan 2018 to Jun 2018. These were case matched with a field infiltration group. We analyse for differences in mean and maximum rest pain scores, opiate requirement, mobilisation status and length of stay (LoS).
No differences were seen in pain scores in the first 24 hours post-operation for DRN block field infiltration groups (2.8 2.7, P=0.90). No reduction in the morphine sulphate equivalents dosage requirement was seen in the DRN group (43.1±46.4 37.6±33.5, P=0.26). Similar proportions of patients mobilised early (P=1.0) and the mean LoS was 1.7 1.8 days (P=0.81).
Dorsal ramus nerve block is not superior to local anaesthetic field infiltration of surgical wound in minor one or two level lumbar spinal decompression surgery in terms of alleviating pain, reducing opiate requirements, or facilitating earlier mobilisation and discharge.
开放性腰椎手术通常会导致严重的术后疼痛。大多数疼痛治疗方案提倡采用多模式方法，旨在减少阿片类药物的用量。这项病例匹配的前瞻性临床研究旨在确定背根神经阻滞用于术后镇痛的疗效。
我们进行了一项病例对照观察性单中心前瞻性研究，研究对象为2018年1月至2018年6月期间连续15例接受单节段腰椎间盘切除术或一/两节段腰椎减压术并接受背根神经阻滞的患者。这些患者与一个局部浸润组进行病例匹配。我们分析了平均和最大静息疼痛评分、阿片类药物用量、活动状态和住院时间（LoS）的差异。
背根神经阻滞组与局部浸润组在术后24小时内的疼痛评分无差异（2.8±2.7，P = 0.90）。背根神经阻滞组硫酸吗啡等效剂量需求未见降低（43.1±46.4对37.6±33.5，P = 0.26）。早期活动的患者比例相似（P = 1.0），平均住院时间为1.7±1.8天（P = 0.81）。
在缓解疼痛、减少阿片类药物用量或促进早期活动和出院方面，背根神经阻滞在小型一或两节段腰椎减压手术中并不优于手术伤口局部麻醉浸润。
