Bernard J M, Surbled M, Lagarde D, Trennec A
Département d'Anesthésie-Réanimation chirurgicale, Hôtel-Dieu, Nantes.
Cah Anesthesiol. 1995;43(6):557-64.
Postoperative pain after spinal surgeries is highly dependent on the number of vertebrae included in the operation and on its invasiveness, opposing two extremes, discectomies and cyphoscoliosis corrections. Opiates by intravenous route remain the reference, either continuously given in predetermined doses, or better using a patient-controlled device. Nonsteroidal and steroidal anti-inflammatory drugs are widely popular for medical approach of sciatalgia and it is quite logical to use them for reducing, even to suppress, opiates after spinal surgeries. Supported by many studies, spinal administration of analgesics (opiates, alpha 2-agonists, corticosteroids) may be of interest in pain treatment of spinal surgeries. In order to prolong locoregional analgesia, a catheter may be inserted into epidural space by caudal route or surgically, before skin closure. Morphine is the most popular agent in this indication. Also, epidural clonidine results in excellent pain relief, but is associated with hypotension and marked sedation. In discectomy, injection of dexamethasone into the operative field has been proposed. Whatever the technique used, early diagnosis of neurological complications of spinal surgery should be not ruled out by postoperative analgesia.
脊柱手术后的疼痛高度依赖于手术中涉及的椎骨数量及其侵袭性，这形成了两个极端，即椎间盘切除术和脊柱侧弯矫正术。静脉注射阿片类药物仍然是标准方法，既可以按预定剂量持续给药，或者更好的是使用患者自控装置。非甾体和甾体类抗炎药在坐骨神经痛的药物治疗中广泛应用，并且在脊柱手术后使用它们来减少甚至停用阿片类药物是很合理的。在许多研究的支持下，椎管内给予镇痛药（阿片类药物、α2-激动剂、皮质类固醇）可能对脊柱手术的疼痛治疗有益。为了延长局部区域镇痛时间，可在关闭皮肤前通过尾侧途径或手术方式将导管插入硬膜外腔。吗啡是该适应证中最常用的药物。此外，硬膜外给予可乐定可产生出色的疼痛缓解效果，但会伴有低血压和明显的镇静作用。在椎间盘切除术中，有人提议在手术区域注射地塞米松。无论采用何种技术，术后镇痛都不应排除对脊柱手术神经并发症的早期诊断。
