Department of Anesthesiology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, China.
Department of Orthopedics, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, China.
Spine J. 2020 Jul;20(7):989-997. doi: 10.1016/j.spinee.2020.03.001. Epub 2020 Mar 13.
Patients undergoing lumbar spinal surgery may experience considerable pain in the early postoperative period, and poor pain control after multilevel lumbar spinal fusion surgery is frequently associated with multiple complications and delayed discharge from hospital.
The current study evaluated the efficacy and safety of preemptive analgesia with intrathecal morphine (ITM) in patients undergoing multilevel posterior lumbar spinal fusion surgery.
Double-blinded, randomized, controlled trial.
Ninety-two patients aged between 18 and 80 years who were scheduled to undergo elective lumbar laminectomy (L3-S1) and dual-level fusions.
The primary endpoint was the degree of postoperative pain at rest and during movement evaluated using a 10-point visual analogue scale. The secondary outcomes included the consumption of analgesics, the patient-assessed postoperative and satisfaction scores, adverse effects, time to first ambulation, and length of hospital stay.
Patients were randomly allocated to either the ITM group that received 0.2 mg of ITM or the control (CON) group that received 2 ml of 0.9% saline as a skin infiltration 30 minutes prior to anesthesia induction.
The ITM group had a significantly lower visual analogue scale score than the CON group during the first 3 days postoperatively (at rest, P=0.000, during movement, P=0.000). The ITM group used significantly less sufentanil than the CON group in the first 3 days postoperatively (p=.000) in patient-controlled intravenous analgesia, as well as in supplemental analgesic demands. The ITM group reported a greater degree of satisfaction with the whole hospitalization experience than the CON group (2.4±0.6 vs. 1.9±0.6, p=.000). The two groups did not significantly differ regarding adverse effects, length of hospital stay, and time taken to regain the ability to walk without support.
Preemptive analgesia with ITM results in significantly improved early postoperative pain control and decreased postoperative patient-controlled intravenous analgesia consumption, with no increase in adverse effects.
接受腰椎脊柱手术的患者在术后早期可能会经历相当大的疼痛，并且在多节段腰椎脊柱融合手术后疼痛控制不佳通常与多种并发症和延迟出院有关。
本研究评估鞘内注射吗啡（ITM）用于多节段后路腰椎脊柱融合术患者的超前镇痛的疗效和安全性。
双盲、随机、对照试验。
92 名年龄在 18 岁至 80 岁之间的患者，计划行选择性腰椎椎板切除术（L3-S1）和双节段融合术。
术后静息和运动时疼痛程度采用 10 分视觉模拟评分法（VAS）评估，这是主要终点。次要结局包括镇痛药的消耗、患者评估的术后和满意度评分、不良反应、首次下床时间和住院时间。
患者随机分配至 ITM 组，在麻醉诱导前 30 分钟给予 0.2mg ITM；或对照组（CON），在麻醉诱导前 30 分钟给予 2ml 0.9%生理盐水作为皮肤浸润。
与 CON 组相比，ITM 组在术后第 1-3 天的 VAS 评分明显较低（静息时，P=0.000；运动时，P=0.000）。在术后第 1-3 天，与 CON 组相比，ITM 组患者自控静脉镇痛（PCIA）中以及补充镇痛需求中使用的舒芬太尼明显减少（p=.000）。与 CON 组相比，ITM 组患者对整个住院体验的满意度更高（2.4±0.6 vs. 1.9±0.6，p=.000）。两组在不良反应、住院时间和恢复无支撑行走能力的时间方面无显著差异。
ITM 超前镇痛可显著改善术后早期疼痛控制，减少术后 PCIA 消耗，且不会增加不良反应。
