Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China.
BMC Anesthesiol. 2020 Nov 18;20(1):288. doi: 10.1186/s12871-020-01205-5.
Surgical procedure usually causes serious postoperative pain and poor postoperative pain management negatively affects quality of life, function and recovery time. We aimed to investigate the role of wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia (PCA) in postoperative pain control for patients undergoing transforaminal lumbar interbody fusion.
One hundred twelve patients undergoing lumbar fusion were retrospectively reviewed and divided into two groups (ropivacaine and control groups) according to whether received wound infiltration with ropivacaine or not. Visual Analogue Scale (VAS) score, analgesics consumption, number of patients requiring rescue analgesic, hospital duration and incidence of complications were recorded. Surgical trauma was assessed using operation time, intraoperative blood loss and incision length.
The amount of sufentanil consumption in ropivacaine group at 4 h postoperatively was lower than that of control group (24.5 ± 6.0 μg vs 32.1 ± 7.0 μg, P < 0.001) and similar results were observed at 8, 12, 24, 48 and 72 h postoperatively(P < 0.001). Fewer patients required rescue analgesia within 4 to 8 h postoperatively in ropivacaine group (10/60 vs 19/52, P = 0.017). Length of postoperative hospital durations were shorter in patients receiving ropivacaine infiltration compared to control cohorts (6.9 ± 0.9 days vs 7.4 ± 0.9 days, P = 0.015). The incidence of PONV in ropivacaine group was lower than that in control group (40.4% vs 18.3%, P = 0.01). However, VAS scores were similar in two groups at each follow-up points postoperatively, and no difference was observed(P > 0.05).
Wound infiltration with ropivacaine effectively reduces postoperative opioid consumption and PONV and may be a useful adjuvant to PCA to improve recovery for patients undergoing lumbar spine surgery.
手术过程通常会引起严重的术后疼痛，而术后疼痛管理不佳会对生活质量、功能和恢复时间产生负面影响。我们旨在研究罗哌卡因伤口浸润作为辅助患者自控镇痛（PCA）在经椎间孔腰椎体间融合术后疼痛控制中的作用。
回顾性分析 112 例接受腰椎融合术的患者，根据是否接受罗哌卡因伤口浸润分为两组（罗哌卡因组和对照组）。记录视觉模拟评分（VAS）评分、镇痛药消耗量、需要解救镇痛的患者人数、住院时间和并发症发生率。手术创伤通过手术时间、术中出血量和切口长度进行评估。
罗哌卡因组患者术后 4 小时舒芬太尼的消耗量低于对照组（24.5±6.0μg vs 32.1±7.0μg，P<0.001），术后 8、12、24、48 和 72 小时也观察到相似的结果（P<0.001）。罗哌卡因组术后 4 至 8 小时内需要解救镇痛的患者较少（10/60 例 vs 19/52 例，P=0.017）。接受罗哌卡因浸润的患者术后住院时间短于对照组（6.9±0.9 天 vs 7.4±0.9 天，P=0.015）。罗哌卡因组术后恶心呕吐（PONV）的发生率低于对照组（40.4% vs 18.3%，P=0.01）。然而，两组患者在术后每个随访点的 VAS 评分相似，差异无统计学意义（P>0.05）。
罗哌卡因伤口浸润可有效减少术后阿片类药物的消耗和 PONV，可能是 PCA 的有效辅助手段，可改善腰椎手术患者的恢复情况。
