Young Ernest Y, Gurd David, Kuivila Thomas, Seif John, Bess Leah, Goodwin Ryan
Department of Orthopedic Surgery, Cleveland Clinic, OH.
Department of Pediatric Anesthesiology, Cleveland Clinic, OH.
Spine (Phila Pa 1976). 2025 Feb 15;50(4):266-270. doi: 10.1097/BRS.0000000000005185. Epub 2024 Oct 15.
Retrospective controlled cohort.
To evaluate the effect of intraoperative liposomal bupivacaine (LB) through erector spinae plane block (ESPB) on patients with postoperative adolescent idiopathic scoliosis (AIS) with and without patient-controlled analgesia (PCA).
Pain control after posterior spinal fusion (PSF) for AIS includes opioids and other modalities. The goal of these modalities is to reduce pain and opioid consumption. Two new modalities for pain control include LB and ESPB. There are scant studies on these modalities tested in concert on patients undergoing PSF for AIS.
Seventy-two consecutive patients with AIS who underwent PSF were separated into patients who had a PCA (group A) as part of their postoperative pain management and those who did not (group B). Opioid consumption was measured through morphine milligram equivalents. Pain scores were measured through the visual acuity score (Visual Analog Scale). Patient mobility was measured by steps taken. These were measured by the function of postoperative days from surgery.
Group B had significantly lower morphine milligram equivalents at every point after surgery, most notably throughout the entire hospital stay (99.8 vs . 200.7). Postoperative pain scores in group B were the same if not better than group A. There was no difference in mobility between the cohorts. Group B had lower LOS (3.7 vs . 4.1).
In postoperative PSF for patients with AIS receiving LB through ESPB, those who did not receive a PCA had lower opioid consumption without worse pain scores or mobility and had a lower LOS. Adding LB through ESPB to postoperative pain regimens effectively replaces a PCA by providing the same pain control and reducing overall opioid consumption and LOS.
回顾性对照队列研究。
评估术中通过竖脊肌平面阻滞（ESPB）使用脂质体布比卡因（LB）对有或没有患者自控镇痛（PCA）的青少年特发性脊柱侧凸（AIS）术后患者的影响。
AIS后路脊柱融合术（PSF）后的疼痛控制包括使用阿片类药物和其他方式。这些方式的目标是减轻疼痛和减少阿片类药物的使用。两种新的疼痛控制方式包括LB和ESPB。关于这些方式联合应用于接受PSF治疗的AIS患者的研究很少。
72例连续接受PSF治疗的AIS患者被分为术后疼痛管理中使用PCA的患者（A组）和未使用PCA的患者（B组）。通过吗啡毫克当量来测量阿片类药物的使用量。通过视力评分（视觉模拟量表）来测量疼痛评分。通过行走步数来测量患者的活动能力。这些指标在术后从手术开始的天数中进行测量。
B组在术后各个时间点的吗啡毫克当量均显著更低，在整个住院期间尤其明显（99.8对200.7）。B组的术后疼痛评分即便不比A组好也相同。两组在活动能力方面没有差异。B组的住院时间更短（3.7对4.1）。
在接受ESPB联合LB治疗的AIS患者术后PSF中，未接受PCA的患者阿片类药物使用量更低，疼痛评分和活动能力没有变差，且住院时间更短。在术后疼痛治疗方案中加入ESPB联合LB能有效替代PCA，提供相同的疼痛控制，减少总体阿片类药物使用量和住院时间。
