Orthopedic Associates of Hartford, Hartford, CT, USA.
Research Department, The Bone and Joint Institute at Hartford Hospital, Hartford, CT, USA.
Spine J. 2022 Oct;22(10):1660-1665. doi: 10.1016/j.spinee.2022.04.019. Epub 2022 May 6.
Anterior lumbar interbody fusion (ALIF) is a well-established technique to address numerous pathological conditions of the spine and to restore sagittal spine balance. Improving patient comfort and reducing opioid consumption following lumbar fusions is a significant goal for spine surgeons. Therefore, there is a growing need to explore multimodal options for pain management post-surgery.
Determine the effectiveness of combined transversus abdominis plane (TAP) and rectus sheath (RS) blocks in those undergoing (ALIF) as compared to a historical control.
STUDY DESIGN/SETTING: Retrospective comparative cohort performed at a tertiary referral orthopedic specialty hospital.
Of the 175 patients (88 patients received a combined regional block) who underwent an ALIF between January 1, 2018 and August 1, 2021.
Pain scores both during activity and at rest, opioid consumption during the first 72 hours postoperatively, total postoperative anesthesia care unit length of stay (PACU LOS), 30-day emergency department visits, 30-day readmissions, and unplanned returns to the operating room.
Charts of patients undergoing an ALIF during the open period for this study were placed into two groups: those that received combined regional anesthesia and those that did not. A t test assuming unequal variances was used to determine if there were differences in outcome variables between the two groups.
The study group, those receiving the combine block, demonstrated a statistically significant reduction in opioid pain medicine (24.8%), reported pain (10-13%), and PACU LOS (18.7%). There were no differences in complication rates between the two groups.
The combined use of TAP and RS blocks appears to be a well-tolerated and effective means of pain management in this patient cohort.
前路腰椎体间融合术（ALIF）是一种成熟的技术，可用于治疗多种脊柱疾病并恢复矢状位脊柱平衡。减少腰椎融合术后患者的舒适度和阿片类药物的使用量是脊柱外科医生的一个重要目标。因此，对于术后疼痛管理，需要探索更多的多模式选择。
与历史对照组相比，确定在接受前路腰椎体间融合术（ALIF）的患者中，联合使用腹横肌平面（TAP）和腹直肌鞘（RS）阻滞的效果。
研究设计/设置：在一家三级转诊骨科专科医院进行回顾性比较队列研究。
在 2018 年 1 月 1 日至 2021 年 8 月 1 日期间，接受 ALIF 的 175 名患者（88 名患者接受了联合区域阻滞）。
活动和休息时的疼痛评分、术后 72 小时内的阿片类药物用量、总术后麻醉护理单元住院时间（PACU LOS）、30 天内急诊就诊、30 天内再入院和计划外返回手术室。
将研究期间接受 ALIF 的患者的病历分为两组：接受联合区域麻醉的患者和未接受联合区域麻醉的患者。采用不等方差 t 检验来确定两组间的结局变量是否存在差异。
研究组（接受联合阻滞的患者）在阿片类止痛药（24.8%）、报告的疼痛（10-13%）和 PACU LOS（18.7%）方面有统计学显著减少。两组间的并发症发生率无差异。
在该患者队列中，联合使用 TAP 和 RS 阻滞似乎是一种耐受良好且有效的疼痛管理方法。
