Multimodal pain control protocol after lumbar spinal fusion

doi:10.3969/j.issn.2095-4344.2014.53.024

Abstract

Abstract:

BACKGROUND: Pathophysiological mechanisms of the pain are mediated by the central and peripheral nerve conduction mechanisms, the commonly used treatment includes analgesic drugs injection, oral analgesic drugs, patient-controlled epidural analgesia, and patient-controlled intravenous analgesia. These methods can reduce clinical pain, but induce some adverse reactions. Multimodal pain control protocol contributes to achieve complete analgesic effect and has clinical innovation significance. Further research is needed to explore clinical efficacy and safety.
OBJECTIVE: To evaluate the therapeutic effect and safety of multimodal pain control protocol on postoperative analgesia of lumbar spinal fusion.
METHODS: Between April 2013 and April 2014, 78 patients undergoing lumbar spinal fusion were chosen for this research, and randomly assigned to experimental group with 39 patients and control group with 39 patients. The experimental group was treated with local injection of morphine, ketorolac, ropivacaine and adrenalin around the incision; the control group was treated with local injection of saline. The VAS score, Ramsay score, the first morphine time, the dose of morphine and adverse reactions immediately and at 6, 12, 24, 48 hours and 7 days after fusion were recorded.
RESULTS AND CONCLUSION: There was no significant difference between the two groups in terms of age, gender, bone mass index, pathogeny and surgical segment. At 6, 12, 24, 48 hours after fusion, the VAS scores in the experimental group were lower (P < 0.05) and the Ramsay scores were higher than the control group (P < 0.05). The VAS scores showed no significant difference between the two groups at 7 days after fusion. The first morphine time was obviously delayed (P=0.002) and the dose of morphine was reduced in the experimental group (P=0.041), which effective controlled perioperative drug use and ensured anesthesia effect. Multimodal pain control protocol is safe and effective in treatment of postoperative pain after lumbar spinal fusion, it significantly reduces the pains after fusion and improves patients’ satisfaction without further adverse reaction.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: lumbar spinal fusion, analgesia, pain measurement, anesthesia

CLC Number:

R318

Li Huan, Ding Wen-ge, Zhu Ding, Yan Wei-hong. Multimodal pain control protocol after lumbar spinal fusion[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(53): 8656-8660.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，本研究以符合纳入标准的腰椎后路融合患者78例为研究对象，随机分为两组，试验组39例，对照组39例。所有患者均获得完整临床随访，全部进入结果分析，无脱落。 2.2 术前一般临床资料比较两组患者在年龄、性别、主要病因、体质量指数、手术节段方面差异无显著性意义 (表1)，具有统计学可比性。结果表明，本试验资料随机分为两组间的预后结果比较具有可比性及可靠性，结果具有临床意义。 2.3 术后患者疼痛评分比较在融合后6，12，24，48 h内，试验组和对照组间的目测类比评分比较差异有显著性意义，试验组疼痛评分明显降低。但在融合后第7天时两组间目测类比评分差异无显著性意义(表2)。结果表明，多模式镇痛处理伤口后腰背部伤口疼痛在48 h内表现出目测类比评分的明显降低，有效控制了机体的急性疼痛。同时在7 d后表现出相同的镇痛效果，表明多模式镇痛控制了急性疼痛，后期镇痛效果基本一致。 2.4 术后患者Ramsay镇静评分比较两组患者在融合后48 h内Ramsay镇静评分间差异有显著性意义，且试验组Ramsay镇静评分显著升高(P < 0.05，表3)。结果表明，多模式镇痛处理伤口后腰背部疼痛融合后48 h内得到了显著改善，降低了急性疼痛的表现，对机体体现出较好的保护作用，增加了患者的临床满意度。 2.5 首次吗啡使用时间、吗啡使用量比较多模式镇痛组融合后首次吗啡使用时间较对照组有明显延迟作用(P=0.002)，同时吗啡使用量也明显降低(P=0.041)，有效控制了临床围手术期的药物使用并保证了镇痛的效果 (表4)。结果表明，多模式镇痛处理伤口后有效保证了药物镇痛持续时间，降低了临床围手术期的药物使用量，较好的控制了药物使用的相关不良作用的发生，保证了效果。 2.6 不良反应记录两组间对于术后常规口服非类固醇药物数量基本相同，不良作用的发生试验组相对较少一些。所有患者未见伤口感染或延迟愈合出现(表5)。结果表明，两组患者在不良反应发生方面未见明显差异，多模式镇痛的使用并没有增加临床并发症的发生，显示出多模式镇痛药物使用的临床安全性。"

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