Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, USA.
Division of Pediatric Surgery, Mayo Clinic, Rochester, MN, USA.
Spine Deform. 2021 Nov;9(6):1601-1607. doi: 10.1007/s43390-021-00381-9. Epub 2021 Jul 15.
Vertebral body tethering is increasingly being performed, yet postoperative pain management has not yet been optimized. We sought to determine whether the addition of a thoracic paravertebral block in addition to a standard multimodal postoperative pain management program could provide greater pain relief, reduced analgesic requirement, and reduced length of stay.
Patients who underwent VBT at a single tertiary referral center were retrospectively reviewed. All patients received a single-shot intrathecal (IT) injection at the completion of the procedure in addition to a standardized multimodal pain management program. 45 patients received a thoracic paravertebral catheter with lidocaine infusion (TPVB) which was left in place for 4-6 days, whereas 24 control patients did not have a TPVB. Length of stay, maximum postoperative Numeric Pain Intensity Scale (NPIS), and total dose of opioids, ibuprofen, ketorolac and acetaminophen administered during hospitalization were evaluated.
69 patients met inclusion criteria. The mean cumulative dose of opioids administered during hospitalization was 148 oral morphine milligram equivalent (MME) in the control group vs. 47 MME in the TPVB group (p < 0.0001). Severe postoperative NPIS of ≥ 7 was reported in 9 out of the 24 control patients (38%) and in 13 out of the 45 patients (29%) who received a TPVB in addition to the standardized care (p = 0.46). There was no significant difference in the mean cumulative dose of NSAIDs (ibuprofen, ketorolac) consumed by the control group compared to the TPVB group (2632 mg vs. 1630 mg, p = 0.77). Mean length of stay in the control group was 3.8 vs. 3.0 days in the TPVB group (p < 0.001). There were no major complications associated with use of the TPVB.
In this series compared to controls, patients treated with a TPVB had reduced postoperative requirement of opioids and decreased length of hospital stay.
椎体固定术的应用日益增多，但术后疼痛管理尚未得到优化。我们旨在确定在标准多模式术后疼痛管理方案的基础上，增加胸椎旁神经阻滞是否能提供更大的疼痛缓解、减少镇痛需求和缩短住院时间。
对在一家三级转诊中心接受 VBT 的患者进行回顾性研究。所有患者在手术完成时均接受单次鞘内（IT）注射，并接受标准多模式疼痛管理方案。45 例患者接受了带利多卡因输注的胸椎旁导管（TPVB），留置 4-6 天，而 24 例对照组患者未接受 TPVB。评估住院期间的住院时间、最大术后数字疼痛强度量表（NPIS）和阿片类药物、布洛芬、酮咯酸和对乙酰氨基酚的总剂量。
69 例患者符合纳入标准。对照组住院期间阿片类药物的累积剂量为 148 口服吗啡毫克当量（MME），TPVB 组为 47 MME（p<0.0001）。24 例对照组中有 9 例（38%）和 45 例接受 TPVB 加标准治疗的患者（29%）报告术后 NPIS 严重（≥7）（p=0.46）。对照组与 TPVB 组消耗的非甾体抗炎药（布洛芬、酮咯酸）的累积剂量无显著差异（2632mg 比 1630mg，p=0.77）。对照组的平均住院时间为 3.8 天，TPVB 组为 3.0 天（p<0.001）。TPVB 无重大并发症。
在本系列研究中，与对照组相比，接受 TPVB 治疗的患者术后阿片类药物需求减少，住院时间缩短。
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