Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi- do, 16988, Republic of Korea.
Department of Orthopedic Surgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, 06273, Republic of Korea.
Eur Spine J. 2024 Nov;33(11):4378-4384. doi: 10.1007/s00586-024-08322-6. Epub 2024 May 27.
Recently, enhanced recovery after surgery (ERAS) protocols have attracted attention; they emphasize on avoiding intraoperative hypothermia while performing lumbar fusion surgery. However, none of the studies have reported the protocol for determining the temperature of saline irrigation during biportal endoscopic spine surgery (BESS) procedure. This study evaluated the effectiveness of warm saline irrigation during BESS in acute postoperative pain and inflammatory reactions.
Fifty-five patients who underwent BESS procedure were retrospectively analyzed for the incidence of perioperative hypothermia (< 36C), postoperative inflammatory factors (white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid A (SAA)), and clinical outcomes (back visual analog scale (VAS) score, postoperative shivering). The patients were divided into the warm and cold saline irrigation groups.
Hemoglobin, WBC, ESR, creatine kinase, and creatine kinase-muscle brain levels did not significantly differ between the warm and cold saline groups. The mean CRP, IL-6, and SAA levels were significantly higher in the cold saline group than in the warm saline group (p = 0.0058, 0.0028, and 0.0246, respectively); back VAS scores were also higher with a statistically significant difference until two days postoperatively (p < 0.001). During the entire procedure, the body temperature was significantly lower in the cold saline irrigation group, but the hypothermia incidence rate significantly differed 30 min after the operation was started.
Using warm saline irrigation during BESS is beneficial for early recovery after surgery, as it is associated with reduced postoperative pain and complication rates.
最近，术后加速康复（ERAS）方案引起了关注；它们强调在进行腰椎融合手术时避免术中低体温。然而，没有一项研究报告过双端口内窥镜脊柱手术（BESS）过程中灌洗生理盐水温度的方案。本研究评估了在 BESS 中使用温热生理盐水对急性术后疼痛和炎症反应的效果。
回顾性分析了 55 例接受 BESS 手术的患者，以评估围手术期低体温（<36°C）、术后炎症因子（白细胞（WBC）、红细胞沉降率（ESR）、C 反应蛋白（CRP）、白细胞介素 6（IL-6）、血清淀粉样蛋白 A（SAA））和临床结果（背部视觉模拟评分（VAS）、术后寒战）的发生率。患者被分为温热生理盐水组和冰冷生理盐水组。
两组间血红蛋白、WBC、ESR、肌酸激酶和肌酸激酶脑水平无显著差异。冰冷生理盐水组的平均 CRP、IL-6 和 SAA 水平明显高于温热生理盐水组（p=0.0058、0.0028 和 0.0246）；背部 VAS 评分在术后两天内也更高，差异具有统计学意义（p<0.001）。整个手术过程中，冰冷生理盐水组的体温明显较低，但术后 30 分钟开始时的低体温发生率差异有统计学意义。
在 BESS 中使用温热生理盐水灌洗有利于术后早期恢复，因为它与术后疼痛和并发症发生率降低有关。
