Department of Orthopedics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
J Orthop Surg Res. 2022 May 26;17(1):290. doi: 10.1186/s13018-022-03178-2.
To investigate whether a cocktail therapy of dexamethasone, ropivacaine, dexmedetomidine, and vitamin B12 can achieve satisfactory pain relief and promote early functional recovery after PPECD.
Eighty single-level patients with CDH who received PPECD were retrospectively divided into two groups: the cocktail and control groups. Clinical data were recorded and evaluated by a dedicated physician who was not involved in the patient's treatment. The primary clinical outcomes included visual analog scores (VASs) for upper limber pain and neck disability index (NDI) scores. The follow-up time points were preoperatively and postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. The modified MacNab criteria was used to evaluate the surgical effect of the last follow-up.
The follow-up data of 74 cases were complete, except 6 cases lost to follow-up. There was no significant difference between the two groups in demographics, duration of symptoms, operation stage (p > 0.05), and operation time (80.5 ± 5.5 vs. 81.5 ± 3.5 min). The VAS in the upper limbs pain was significantly higher postoperatively than preoperatively in both groups (p < 0.05). The cocktail group had a lower VAS than the control group 1 week postoperatively (p < 0.05); however, VAS not different between groups at the remaining time points. The NDI scores were significantly better postoperatively than preoperatively, and no significant differences were seen when comparing nodes at postoperative follow-up (p > 0.05). In the control group, two cases with foraminal stenosis were found to have unrelieved pain in the early postoperative period, but the pain was relieved at the final follow-up and did not convert to open decompression surgery.
Cocktail treatment, in which a drug sustained-release material made of gelatin sponge was impregnated with dexamethasone, ropivacaine, dexmedetomidine and vitamin B12, facilitates pain relief and early postoperative recovery after PPECD.
探讨地塞米松、罗哌卡因、右美托咪定和维生素 B12 鸡尾酒疗法能否在经皮内镜颈椎间盘切除术（PPECD）后达到满意的镇痛效果并促进早期功能恢复。
回顾性分析 80 例单节段颈椎间盘突出症（CDH）患者行 PPECD 的临床资料，按治疗方法分为鸡尾酒组和对照组。由不参与患者治疗的专科医生记录并评估临床数据。主要临床结局包括上肢疼痛视觉模拟评分（VAS）和颈残障指数（NDI）评分。随访时间点为术前及术后 1 周、1 个月、3 个月、6 个月和 12 个月。末次随访时采用改良 MacNab 标准评价手术效果。
74 例患者完成随访，6 例失访。两组患者一般资料、症状持续时间、手术节段（p>0.05）和手术时间（80.5±5.5 比 81.5±3.5 min）差异均无统计学意义。两组术后上肢疼痛 VAS 评分均高于术前（p<0.05）。鸡尾酒组术后 1 周 VAS 评分低于对照组（p<0.05），其余时间点两组间 VAS 评分差异无统计学意义。两组术后 NDI 评分均优于术前，各随访时间点组间 NDI 评分差异无统计学意义（p>0.05）。对照组术后早期有 2 例出现椎间孔狭窄，诉疼痛未缓解，但最终随访时疼痛缓解，未行开放减压手术。
地塞米松、罗哌卡因、右美托咪定和维生素 B12 制成的凝胶海绵载药缓释材料（鸡尾酒治疗）可促进 PPECD 术后疼痛缓解和早期康复。
