腰椎交感神经节阻滞对腰椎手术失败综合征患者的镇痛效果。

The analgesic effect of lumbar sympathetic ganglion block in patients with failed back surgery syndrome.

作者信息

Lee Jin Young, Sim Woo Seog, Kim Jiyoung, Yang Sungwon, Ro Hojun, Kim Chang Jae, Kim Sung Un, Park Hue Jung

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.

Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Front Med (Lausanne). 2023 Jan 12;9:999655. doi: 10.3389/fmed.2022.999655. eCollection 2022.

DOI:10.3389/fmed.2022.999655

PMID:36714111

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9877287/

Abstract

BACKGROUND

Persistent or recurrent lumbosacral pain is a common symptom after spinal surgery. Several interventions have been introduced for failed back surgery syndrome; however, their clinical efficacy, safety, and cost-effectiveness are insufficient. Sympathetic ganglion block has been selected for pain associated with the sympathetic nervous system. In this study, we compared pain and quality of life in patients with failed back surgery syndrome who responded and did not respond to lumbar sympathetic ganglion block.

METHODS

We included 84 patients diagnosed with failed back surgery syndrome who had lumbosacral pain and underwent lumbar sympathetic ganglion block between January 2020 and April 2021. The patients' data were retrospectively analyzed; clinical outcomes were assessed before (T0), 1 week after (T1), and 4 weeks after (T4) lumbar sympathetic ganglion block. Based on the pain difference from T0 to T1, we categorized patients into two groups: patients with ≥ 50% pain reduction (responder group) and patients with < 50% pain reduction (non-responder group). Demographic, clinical, surgical, and fluoroscopic data were evaluated and compared. The primary outcome was pain scores and the EuroQol-5D score from T0 to T4.

RESULTS

Among the 84 patients analyzed, 41 (48.8%) experienced ≥ 50% pain reduction at 1 week after lumbar sympathetic ganglion block. Lumbar sympathetic ganglion block significantly improved pain at T1 and T4 compared to T0 in both groups. Lumbar sympathetic ganglion block improved the EuroQol-5D score at T1 compared to T0 in the responder group. The responder group had a significant decrease in pain at T1 from T0 and T4 from T0 and a significant decrease in the EuroQol-5D score at T1 from T0 compared with the non-responder group. Coldness of the leg over time did not differ between the groups. No serious adverse events occurred in either of the groups.

CONCLUSION

Lumbar sympathetic ganglion block may improve pain at 1 and 4 weeks in patients with failed back surgery syndrome. Patients with ≥ 50% pain reduction at 1 week showed simultaneous improvement in quality of life and pain reduction at 4 weeks.

CLINICAL TRIAL REGISTRATION

https://cris.nih.go.kr/cris/index/index.do, identifier KCT0007236.

摘要

背景

持续性或复发性腰骶部疼痛是脊柱手术后的常见症状。针对失败的脊柱手术综合征已引入了多种干预措施；然而，它们的临床疗效、安全性和成本效益并不理想。交感神经节阻滞已被用于治疗与交感神经系统相关的疼痛。在本研究中，我们比较了对腰交感神经节阻滞有反应和无反应的失败脊柱手术综合征患者的疼痛和生活质量。

方法

我们纳入了84例在2020年1月至2021年4月期间被诊断为失败脊柱手术综合征且有腰骶部疼痛并接受腰交感神经节阻滞的患者。对患者的数据进行回顾性分析；在腰交感神经节阻滞前（T0）、阻滞1周后（T1）和阻滞4周后（T4）评估临床结局。根据从T0到T1的疼痛差异，我们将患者分为两组：疼痛减轻≥50%的患者（反应者组）和疼痛减轻<50%的患者（无反应者组）。对人口统计学、临床、手术和透视数据进行评估和比较。主要结局是从T0到T4的疼痛评分和欧洲五维健康量表（EuroQol-5D）评分。

结果

在分析的84例患者中，41例（48.8%）在腰交感神经节阻滞1周后疼痛减轻≥50%。与T0相比，两组在T1和T4时腰交感神经节阻滞均显著改善了疼痛。与T0相比，反应者组在T1时腰交感神经节阻滞改善了欧洲五维健康量表评分。与无反应者组相比，反应者组在T1时与T0相比疼痛显著降低，在T4时与T0相比疼痛显著降低，在T1时与T0相比欧洲五维健康量表评分显著降低。两组随时间推移腿部发冷情况无差异。两组均未发生严重不良事件。