比较罗哌卡因止血明胶海绵和生理盐水对脊柱内固定手术患者术后疼痛的影响：一项随机临床试验
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Comparison of Effects of Hemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline Applied on the Transverse Process of the Operated Vertebrae on Postoperative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial
背景与目的
目前，对于脊柱手术患者术后疼痛的控制尚无确切方案。本研究旨在比较应用含罗哌卡因可吸收明胶海绵和生理盐水对行脊柱内固定术患者术后疼痛的影响。
方 法
本次前瞻性双盲随机对照试验共纳入30例脊柱手术患者。在手术结束时，由外科医生将含有0.5%罗哌卡因或0.9%生理盐水的止血明胶海绵涂抹在患者手术椎体的横突上。 在两组(罗哌卡因与生理盐水)术后48小时内，每4小时使用视觉模拟评分(VAS)评估患者疼痛程度。同时记录术后阿片类药物的总使用量。
结 果
术后48小时，接受局部麻醉药浸泡的止血明胶海绵患者的VAS评分显著低于接受生理盐水浸泡的明胶海绵患者。此外，接受局部麻醉药浸泡的止血明胶海绵患者术后48h内阿片类药物的平均总消耗量(53.5±51.0 mg)也明显低于使用生理盐水浸泡止血明胶海绵的患者(140.5±102mg)，差异有统计学意义(P<0.05)。
结 论
术中，罗哌卡因止血海绵在手术椎骨横突中的应用，可减少腰椎内固定手术患者的术后疼痛，表现为VAS评分和阿片类药物总剂量的降低。
原始文献摘要
Ghabach MB, Mhanna NE, Abou Al Ezz MR, et al. Comparison of Effects of Hemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline Applied on the Transverse Process of the Operated Vertebrae on Postoperative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial.[J] .World Neurosurg, 2019.
Background: Protocols for effective postoperative pain control in patients undergoing spinal surgery are not standardized. In our study, we compared the effects of hemostatic absorbable gelatin sponge impregnated with ropivacaine versus normal saline when applied to the transverse process of the operated vertebrae on the postoperative pain following instrumentation spine surgery.
Methods: A prospective double-blind randomized study was conducted on 30 patients undergoing spine surgery. At the end of surgery, the hemostatic gelatin sponge was applied by the surgeon on the transverse process of the operated vertebra containing either ropivacaine 0.5% or normal saline NaCl 0.9. Pain was assessed using the visual analog scale (VAS) every 4 hours for 48 hours postoperatively in the 2 groups (ropivacaine vs. normal saline). The total amount of postoperative opioid use was also recorded.
Results: The VAS score was significantly lower in patients receiving hemostatic gelatin sponge impregnated with local anesthetics as compared with patients receiving gelatin sponge impregnated with normal saline 48 hours postoperatively; the mean total dose of meperidine given in the first 48 hours postoperatively was significantly lower (53.5±51.0 mg) in patients receiving gelatin sponge impregnated with local anesthetics as compared with patients receiving hemostatic gelatin sponge impregnated with normal saline (140.5±102 mg).
Conclusions: Use of intraoperative hemostatic gelatin sponge impregnated with ropivacaine applied on the transverse process of the operated vertebrae intraoperatively resulted in decreasing the postoperative pain in patients undergoing lumbar instrumentation surgery as manifested by the decrease in the VAS score and the total dose of opioids.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙