针刺治疗退行性腰椎手术后疼痛控制。
Acupuncture for pain control after degenerative lumbar spine surgery.
机构信息
Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
出版信息
Eur J Med Res. 2022 Sep 1;27(1):167. doi: 10.1186/s40001-022-00797-7.
BACKGROUND
Wound pain after surgery for lumbar spine disease may interfere with patients' recovery. Acupuncture is commonly used for pain management, but its efficacy for postoperative pain control is unclear. This study aimed to evaluate the effectiveness of acupuncture for adjuvant pain control after surgery for degenerative lumbar spine disease.
METHODS
We retrospectively reviewed the records of consecutive patients who received surgery for degenerative lumbar spine disease at our institution from 2013 to 2014. Surgical procedures included open laminectomy, discectomy, and trans-pedicle screw instrumentation with posterior-lateral fusion. Patients were grouped by pain control methods, including routine analgesia, patient-controlled analgesia (PCA), and acupuncture. The routine analgesia group received oral acetaminophen/non-steroidal anti-inflammatory drugs with meperidine as needed for immediate pain control. The PCA group received a basal dose of morphine and subsequent user-demand doses. The acupuncture group received acupuncture every other day after surgery.
RESULTS
Ninety-six patients were included, of whom 37 received acupuncture, 27 received PCA, and 32 received routine analgesics for pain control. Visual analog scale (VAS) pain scores in all 3 groups decreased significantly, and to the same degree, from the first postoperative day to the second day. No significant differences were found in VAS scores over the next 6 postoperative days; however, the scores of patients treated with PCA were slightly but still significantly higher (p = 0.026) on postoperative day 4 than scores of patients treated with acupuncture and traditional analgesia, a difference likely due to PCA being discontinued on postoperative day 3. No major complications were noted in the acupuncture group, but 2 patients dropped out because of fear of needle insertion.
CONCLUSIONS
Acupuncture may be as effective as traditional analgesia and PCA for adjuvant pain control after surgery for degenerative lumbar spine disease.
背景
腰椎疾病手术后的伤口疼痛可能会干扰患者的康复。针灸常用于疼痛管理，但对于术后疼痛控制的疗效尚不清楚。本研究旨在评估针灸对退行性腰椎疾病手术后辅助止痛的效果。
方法
我们回顾性分析了 2013 年至 2014 年在我院接受退行性腰椎疾病手术的连续患者的病历。手术方法包括开放性椎板切除术、椎间盘切除术和经皮椎弓根螺钉内固定后外侧融合术。根据疼痛控制方法将患者分组，包括常规镇痛、患者自控镇痛（PCA）和针灸。常规镇痛组接受口服扑热息痛/非甾体抗炎药，并按需给予哌替啶以即刻控制疼痛。PCA 组给予基础剂量吗啡和随后的按需剂量。针灸组在手术后每隔一天接受一次针灸。
结果
共纳入 96 例患者，其中 37 例接受针灸，27 例接受 PCA，32 例接受常规镇痛以控制疼痛。所有 3 组的视觉模拟评分（VAS）疼痛评分均显著下降，且从术后第 1 天到第 2 天降至相同程度。在接下来的 6 天术后，VAS 评分无显著差异；然而，在术后第 4 天，接受 PCA 治疗的患者的评分略高但仍有显著差异（p = 0.026），这可能是因为 PCA 在术后第 3 天停止。针灸组未出现重大并发症，但有 2 例因害怕针刺而退出。
结论
针灸可能与传统镇痛和 PCA 一样有效，可作为退行性腰椎疾病手术后辅助止痛的方法。
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