Chaibhuddanugul Nattharut, Weerakul Santi, Laoruengthana Artit, Varakornpipat Panapol, Sudbanthad Pawin, Mahatthanatrakul Akaworn
Department of Orthopaedics, Naresuan University Hospital, Phitsanulok, Thailand.
Spine (Phila Pa 1976). 2024 Dec 15;49(24):1716-1721. doi: 10.1097/BRS.0000000000004998. Epub 2024 Apr 1.
Randomized double-blind controlled trial.
The purpose of this study was to determine the efficacy of pain control and opioid consumption after administration of ketorolac directly to paraspinal muscle after spinal fusion.
Ketorolac is added to multimodal analgesia regimens to improve pain control, reduce opioid consumption following orthopaedics and spine surgery. However, evidence of the efficacy of adding ketorolac to local anesthesia for intrawound infiltration after spine surgery is still limited.
The patients who underwent multilevel lumbar decompression and posterolateral fusion were recruited and randomized to the control group which received 0.5% bupivacaine hydrochloride injected into paraspinal muscles before wound closure, and the ketorolac group which received 30 mg ketorolac in addition to 0.5% bupivacaine hydrochloride. Postoperative numerical rating scale (NRS) for back pain, leg pain, morphine consumption, and adverse events were recorded.
A total of 47 patients were randomized (24 in the ketorolac group and 23 in the control group). The mean age was 60.9±6.9 years old. The mean NRS for back pain at 6 hours after surgery was 5.8±3.0 points for the control group and 3.3±2.1 points for the ketorolac group ( P <0.01). The ketorolac group consumed lesser morphine than the control group by 9.1 mg in the first 24 hours, 13.8 mg at 48 hours, 14.3 mg at 72 hours, and 13.9 mg at 96 hours after the surgery ( P <0.05). Postoperative complications were not different between the two groups.
The addition of ketorolac to bupivacaine for wound infiltration after posterior lumbar spine decompression and fusion reduces early postoperative pain and total morphine consumption as compared with bupivacaine alone.
随机双盲对照试验。
本研究旨在确定脊柱融合术后将酮咯酸直接注射到椎旁肌后疼痛控制及阿片类药物用量的疗效。
酮咯酸被添加到多模式镇痛方案中以改善疼痛控制，减少骨科和脊柱手术后的阿片类药物用量。然而，脊柱手术后将酮咯酸添加到局部麻醉用于伤口浸润的疗效证据仍然有限。
招募接受多节段腰椎减压及后外侧融合术的患者，并随机分为对照组和酮咯酸组。对照组在伤口闭合前接受0.5%盐酸布比卡因注射到椎旁肌，酮咯酸组除接受0.5%盐酸布比卡因外还接受30mg酮咯酸。记录术后背痛、腿痛的数字评定量表（NRS）、吗啡用量及不良事件。
共47例患者被随机分组（酮咯酸组24例，对照组23例）。平均年龄为60.9±6.9岁。术后6小时对照组背痛的平均NRS为5.8±3.0分，酮咯酸组为3.3±2.1分（P<0.01）。酮咯酸组术后24小时比对照组少用吗啡9.1mg，48小时少用13.8mg，72小时少用14.3mg，96小时少用13.9mg（P<0.05）。两组术后并发症无差异。
与单独使用布比卡因相比，腰椎后路减压融合术后伤口浸润时在布比卡因中添加酮咯酸可减轻术后早期疼痛并减少吗啡总用量。
