Kumar Manoj, Srivastava Saumya, Singh Dheer, Yadav Jay Brijesh Singh, Kumar Vimal
Anaesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, IND.
Surgery, North Delhi Municipal Corporation (NDMC) Medical College and Hindu Rao Hospital, New Delhi, IND.
Cureus. 2022 Mar 28;14(3):e23592. doi: 10.7759/cureus.23592. eCollection 2022 Mar.
Pain relief after surgery continues to be a major medical challenge in clinical practice. Lumbar spine surgery is associated with significant postoperative pain. Providing optimal analgesia locally in the area of surgical wound, with little systemic side-effects, is a favourable option and has become an intrinsic part of multimodal analgesia. We aimed to assess and compare the effectiveness of local infiltration and instillation of bupivacaine for postoperative analgesia in patients undergoing lumbar spine surgery.
Forty-four adult patients of the American Society of Anesthesiologists (ASA) class I and II were randomly assigned into two groups, incorporating 22 patients per group. After the completion of lumbar spine surgery and after hemostasis was achieved, patients in group A received instillation of 20 ml of 0.25% bupivacaine at the surgical wound site and patients in group B received 20 ml of 0.25% bupivacaine infiltration into the paravertebral muscles on either side. Postoperative numerical rating scale (NRS) pain scores at 1, 2, 3, 4, 5, 6, 7, 8, 14, 20, and 24 hours; the time to first analgesic required, total rescue analgesic consumption, and adverse effects were recorded. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp, Armonk, New York, United States).
Time to the first analgesic requirement was significantly longer in group A (12.39±1.56 hours) compared to the B group (2.48±0.58 hours) (P < 0.001). The amount of rescue analgesia (diclofenac sodium) required was significantly higher in group B (135.00±46.17 milligrams) compared to A (93.75±33.32 milligrams) (P = 0.001). The number of analgesic demands was higher in the infiltration group compared to the instillation group and was observed to be statistically significant. Hemodynamic parameters remained comparable between the groups.
Local instillation of surgical wound site provided better pain control than infiltration technique and is effective and safe postoperative analgesia in patients undergoing laminectomy surgeries.
术后疼痛缓解仍是临床实践中的一项重大医学挑战。腰椎手术会导致显著的术后疼痛。在手术伤口局部提供最佳镇痛效果，同时全身副作用较小，是一种理想的选择，已成为多模式镇痛的一个内在组成部分。我们旨在评估和比较布比卡因局部浸润和滴注对腰椎手术患者术后镇痛的效果。
44例美国麻醉医师协会（ASA）I级和II级成年患者被随机分为两组，每组22例。腰椎手术完成并止血后，A组患者在手术伤口部位滴注20 ml 0.25%布比卡因，B组患者在两侧椎旁肌浸润20 ml 0.25%布比卡因。记录术后1、2、3、4、5、6、7、8、14、20和24小时的数字评分量表（NRS）疼痛评分；首次需要镇痛的时间、总补救镇痛药消耗量及不良反应。使用IBM SPSS Statistics for Windows 20.0版（2011年发布；IBM公司，美国纽约州阿蒙克）进行统计分析。
A组首次需要镇痛的时间（12.39±1.56小时）明显长于B组（2.48±0.58小时）（P<0.001）。B组所需的补救镇痛药（双氯芬酸钠）量（135.00±46.17毫克）明显高于A组（93.75±33.32毫克）（P = 0.001）。浸润组的镇痛需求次数高于滴注组，且具有统计学意义。两组间血流动力学参数保持相当。
手术伤口部位局部滴注比浸润技术能提供更好的疼痛控制，对接受椎板切除术的患者是有效且安全的术后镇痛方法。
