利多卡因联合 Esketamine 用于接受经皮椎体后凸成形术局部麻醉的老年患者的疼痛改善：一项随机对照研究。

Improvement in pain by using lidocaine combined with esketamine in elderly patients receiving local anaesthesia for percutaneous kyphoplasty: a randomized controlled study.

机构信息

Department of Anesthesia, The Affiliated Lihuili Hospital of Ningbo University, NO 1111 Jiangnan Road, Yinzhou District, Ningbo City, Zhejiang Province, 315040, P.R. China.

出版信息

BMC Anesthesiol. 2024 Oct 23;24(1):384. doi: 10.1186/s12871-024-02768-3.

DOI:10.1186/s12871-024-02768-3

PMID:39443898

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11498954/

Abstract

BACKGROUND

Elderly patients often experience severe pain during percutaneous kyphoplasty under local anaesthesia. The aim of this work was to evaluate the effect of lidocaine combined with esketamine on pain improvement in elderly patients receiving local anaesthesia via percutaneous kyphoplasty.

METHODS

This prospective, randomized comparative trial was conducted on 66 elderly patients, aged 60-80 years, with an American Society of Anaesthesiologists (ASA) grade of I-III, I‒III and a BMI of 18.5-25 kg/m, who underwent single-level lumbar percutaneous kyphoplasty under local anaesthesia. Patients were divided into two equal groups (33 per group). Group LE received 200 mg of 1% lidocaine and 25 mg of esketamine (total volume of 20 ml), and Group L received 200 mg of 1% lidocaine (total volume of 20 ml). Patient characteristics, surgery, VAS scores, MAP, HR, MOAA/S scores, patient satisfaction and related adverse reactions were compared for the groups. The VAS scores during and after surgery were considered the primary outcome.

RESULTS

There were statistically significant differences in the VAS score between the two groups at the following time points: channel establishment by the puncture needle, balloon dilation, bone cement injection and postoperative period (P < 0.05). The VAS score decreased in the LE group, but the MAP and HR were more stable, and the difference was statistically significant (P < 0.05). The difference in the MOAA/S score between the two groups was statistically significant (P < 0.05), and the MOAA/S score in the LE group decreased. The patient satisfaction level in the LE group was 100% and 48.48% in the L group (P < 0.05). There were no related complications or adverse reactions in either group.

CONCLUSION

The application of lidocaine combined with esketamine in local episcopal percutaneous vertebral kyphoplasty in elderly patients not only provides an effective analgesic effect but also improves surgical safety and patient comfort, which has important clinical value in promoting the optimization of surgical anaesthesia management in elderly patients.

TRIAL REGISTRATION

The study was registered at Chictr.org.cn with the number ChiCTR2400083466 on 06/12/2023.

摘要

背景

在局部麻醉下进行经皮椎体后凸成形术时，老年患者常经历剧烈疼痛。本研究旨在评估利多卡因联合 Esketamine 对接受局部麻醉行经皮椎体后凸成形术的老年患者疼痛改善的效果。

方法

本前瞻性、随机对照试验纳入 66 名年龄在 60-80 岁、ASA 分级 I-III 级、BMI 为 18.5-25kg/m 的老年患者，这些患者接受单节段腰椎经皮后凸成形术，采用局部麻醉。患者被分为两组（每组 33 名）。LE 组接受 200mg1%利多卡因和 25mg Esketamine（总量 20ml），L 组接受 200mg1%利多卡因（总量 20ml）。比较两组患者的特征、手术、VAS 评分、MAP、HR、MOAA/S 评分、患者满意度和相关不良反应。术中及术后 VAS 评分作为主要观察指标。

结果

两组患者在以下时间点的 VAS 评分存在统计学差异：穿刺针通道建立、球囊扩张、骨水泥注入和术后（P<0.05）。LE 组 VAS 评分降低，但 MAP 和 HR 更稳定，差异具有统计学意义（P<0.05）。两组 MOAA/S 评分差异有统计学意义（P<0.05），LE 组 MOAA/S 评分降低。LE 组患者满意度为 100%，L 组为 48.48%（P<0.05）。两组均无相关并发症或不良反应。