Doherty Tara M, Zhang Ailan, Spivak Alla, Kiley Ellen, DelBello Damon, Abramowicz Apolonia E, Xu Jeff L
Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
Department of Public Health, New York Medical College School of Health Sciences and Practice, Valhalla, NY, USA.
Int J Spine Surg. 2024 Jul 4;18(3):329-335. doi: 10.14444/8601.
Approximately 38,000 scoliosis surgery correction operations are performed annually in the United States; these operations are associated with considerable postoperative pain which can be difficult to manage. This is largely attributed to an incision spanning multiple vertebral segments with paraspinal muscle dissection and retraction to facilitate the implantation of segmental hardware and rods. Frequently utilized analgesic modalities include intravenous patient-controlled analgesia and epidural analgesia, often in combination. We sought to ascertain the feasibility and analgesic efficacy of continuous thoracolumbar dorsal ramus nerve (TDRN) block using surgically placed multiorifice catheters.
Forty-two patients diagnosed with idiopathic scoliosis who underwent a posterior spinal fusion (PSF) were enrolled after consent was obtained. Patients were managed utilizing a standardized Enhanced Recovery After Surgery) protocol including a perioperative opioid-sparing regimen. Data were collected at specified time intervals during the recovery period. These data points included pain scores using the Numeric Rating Scale. Parenteral or both oral and parenteral opioid consumption doses were also collected every 4 hours. Any significant postoperative adverse events were recorded as well.
A total of 42 patients had surgically placed TDRN catheters, and 40 patients were included in this study. The patients all reported low to moderate pain scores with low opioid consumption postoperatively, while the TDRN catheter delivery of local anesthetic analgesics did not result in significant complications.
A regional technique utilizing TDRN catheters could be a valuable component of the postoperative pain management protocols for PSF surgery, and additional studies are warranted.
This study evaluated the feasibility and analgesic efficacy of TDRN catheters for postoperative pain control following multilevel PSF for idiopathic scoliosis. Continuous local anesthetic delivery through TDRN catheters is a feasible and safe technique for postoperative pain control in these patients. Selective blockade of the dorsal rami might have benefits over epidural analgesia or other regional techniques.
在美国，每年大约进行38000例脊柱侧弯手术矫正手术；这些手术会带来相当严重的术后疼痛，且难以控制。这在很大程度上归因于切口跨越多个椎体节段，伴有椎旁肌的解剖和牵拉，以利于节段性硬件和棒的植入。常用的镇痛方式包括静脉自控镇痛和硬膜外镇痛，且常常联合使用。我们试图确定使用手术放置的多孔导管进行连续胸腰段背根神经（TDRN）阻滞的可行性和镇痛效果。
42例诊断为特发性脊柱侧弯并接受后路脊柱融合术（PSF）的患者在获得同意后入组。患者采用标准化的术后加速康复方案进行管理，包括围手术期阿片类药物节约方案。在恢复期的特定时间间隔收集数据。这些数据点包括使用数字评分量表的疼痛评分。每4小时还收集胃肠外或胃肠外与口服联合使用的阿片类药物消耗剂量。记录任何显著的术后不良事件。
共有42例患者手术放置了TDRN导管，本研究纳入了40例患者。所有患者术后均报告疼痛评分低至中度，阿片类药物消耗量低，而TDRN导管给予局部麻醉镇痛药未导致显著并发症。
利用TDRN导管的区域技术可能是PSF手术术后疼痛管理方案的一个有价值的组成部分，有必要进行更多研究。
本研究评估了TDRN导管用于特发性脊柱侧弯多节段PSF术后疼痛控制的可行性和镇痛效果。通过TDRN导管持续给予局部麻醉药是这些患者术后疼痛控制的一种可行且安全的技术。背根神经的选择性阻滞可能比硬膜外镇痛或其他区域技术更具优势。
