|
| 布比卡因脂质体改良胸腰筋膜间平面阻滞对内镜下后路腰椎融合术后镇痛效果的影响 |
| Effect of liposomal bupivacaine modified thoracolumbar interfascial plane block on postoperative analgesia following endoscopic posterior lumbar interbody fusion |
| |
| DOI：10.12089/jca.2026.02.005 |
| 中文关键词: 布比卡因脂质体 改良胸腰筋膜间平面阻滞 脊柱内镜 腰椎 镇痛 |
| 英文关键词: Liposomal bupivacaine Modified thoracolumbar interfascial plane block Spinal endoscopy Lumbar spine Analgesia |
| 基金项目:宿迁市科技计划项目（SY202423） |
|
| 摘要点击次数: 1033 |
| 全文下载次数: 317 |
| 中文摘要: |
目的：探讨布比卡因脂质体行改良胸腰筋膜间平面阻滞（mTLIP）对内镜下后路腰椎融合术（Endo-PLIF）患者术后镇痛效果的影响。
方法：选择择期行Endo-PLIF患者，年龄40～70岁，ASAⅠ或Ⅱ级。采用随机数字表法分为两组:全身麻醉联合mTLIP阻滞组（观察组）和全身麻醉组（对照组）。观察组患者采用全身麻醉联合布比卡因脂质体行双侧mTLIP阻滞，对照组患者只实施全身麻醉。主要指标为术后48 h内羟考酮用量。次要指标包括术中丙泊酚、瑞芬太尼用量，术后24、72 h内羟考酮用量，术后6、24、48、72 h数字评定量表（NRS）疼痛评分，镇痛泵按压次数、补救性镇痛例数，术后首次下床时间、术后住院时间。不良反应包括穿刺点血肿、局麻药中毒、感染、神经损伤等神经阻滞并发症发生情况，术后72 h内恶心呕吐、皮肤瘙痒、呼吸抑制等。
结果：共纳入患者80例，每组40例。与对照组比较，观察组术后24、48和72 h内羟考酮用量明显减少，术中瑞芬太尼用量明显减少，术后6、24、48和72 h NRS疼痛评分明显降低，术后72 h内恶心呕吐发生率、镇痛泵按压次数、补救性镇痛例数明显减少，术后首次下床时间［19.0（14.0～21.8）h vs. 29.0（24.3～33.8）h］、术后住院时间［8.0（7.0～9.0）d vs. 9.0（7.3～11.8）d］明显缩短（P<0.05）。两组术中丙泊酚用量差异无统计学意义。
结论：布比卡因脂质体双侧mTLIP阻滞，可显著改善Endo-PLIF患者围术期疼痛，减少镇痛药物用量以及并发症，有助于患者尽早下床活动，缩短术后住院时间，促进患者早期恢复。 |
| 英文摘要: |
Objective: To investigate the influence of liposomal bupivacaine in modified thoracolumbar interfascial plane block (mTLIP) on postoperative analgesic effects in patients undergoing endoscopic posterior lumbar interbody fusion (Endo-PLIF).
Methods: Patients undergoing elective Endo-PLIF were selected, aged 40-70 years, ASA physical status Ⅰ or Ⅱ. They were randomly divided into the general anesthesia combined with mTLIP block group (observation group) and the general anesthesia group (control group) by random number table method. Patients in the observation group received general anesthesia combined with bupivacaine liposome for bilateral mTLIP block, while patients in the control group only received general anesthesia. The primary outcome was the cumulative oxycodone consumption at 48 hours postoperatively. Secondary outcomes included intraoperative propofol and remifentanil consumption, oxycodone consumption 24 and 72 hours postoperatively, numerical rating scale (NRS) pain scores 6, 24, 48, and 72 hours postoperatively, the number of patient-controlled analgesia pump boluses, the number of patients requiring rescue analgesia, time to first ambulation and the postoperative hospital stay. Adverse reactions included nerve block-related complications such as puncture site hematomae, local anesthetic toxicity, infection, nerve injury, also included nausea and vomiting, skin itching, respiratory depression within 72 hours postoperatively.
Results: Eighty patients were enrolled in this study, 40 patients in each group. Compared with the control group, the observation group exhibited significantly reduced in the cumulative oxycodone consumption 24, 48, and 72 hours postoperatively, reduced intraoperative remifentanil consumption, decreased NRS pain scores 6, 24, 48, and 72 hours postoperatively. Additionally, the incidence of nausea and vomiting within 72 hours, the number of patient-controlledanalgesic pump boluses, and the number of patients requiring rescue analgesia were significantly decreased. The time to first ambulation [19.0 (14.0-21.8) hours vs. 29.0 (24.3-33.8) hours] and postoperative hospital stay [8.0 (7.0-9.0) days vs. 9.0 (7.3-11.8) days] were significantly shorter (P < 0.05). There was no statistically significant difference in intraoperative propofol consumption between the two groups.
Conclusion: Bilateral mTLIP block usingliposomal bupivacaine can significantly alleviate perioperative pain in patients undergoing Endo-PLIF, reduce the dosage of analgesic drugs and complications, facilitate patients' early ambulation, shorten the postoperative hospital stay, and promote early recovery of patients. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
