“切口外”:腰椎手术中静脉注射和硬膜外先发制人镇痛的病例对照研究。

IF 2.6 3区 医学 Q2 CLINICAL NEUROLOGY
Akhil Xavier Joseph, Alia Vidyadhara, Anjana Kashyap, Abhishek Soni, Balamurugan Thirugnanam, Madhava Pai, Vidyadhara S
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引用次数: 0

摘要

引言:腰椎手术中有效的疼痛管理是提高术后恢复和减少并发症的关键。静脉注射或硬膜外注射先发制人的镇痛已显示出控制疼痛的希望;然而,比较这两种途径直接确定腰椎手术最佳入路的数据有限。目的:评价和比较静脉注射和硬膜外先发制人镇痛方式在腰椎手术中的疼痛控制效果、恢复结果和术后并发症。方法:一项前瞻性双盲研究,比较静脉(IV)和硬膜外先发制人镇痛在腰椎手术患者中的疗效。腰椎手术患者根据镇痛方式分为硬膜外镇痛组、静脉镇痛组和对照组。术后评估疼痛评分、镇痛药消耗和恢复情况。统计分析,包括方差分析和卡方检验,评估组间疼痛控制和恢复结果的差异。结果:各组术后4、8、12、24 h VAS评分差异有统计学意义(p)。结论:本研究通过直接比较静脉注射与硬膜外先发制人镇痛在腰椎手术中的应用,填补了一个关键空白,为临床决策提供参考。研究结果表明,静脉镇痛与硬膜外镇痛具有相当的疼痛控制效果,是一种更安全、手术风险更小的替代方法。结果对优化围手术期护理具有重要意义。证据等级:四级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
"Beyond the incision": A case-control study on IV and epidural pre-emptive analgesia in lumbar spine surgery.

Introduction: Effective pain management in lumbar spine surgery is critical to enhancing postoperative recovery and minimizing complications. Preemptive analgesia, administered either intravenously or epidurally, has shown promise in controlling pain; however, limited data exist comparing the two routes directly to determine the optimal approach for lumbar procedures.

Purpose: To evaluate and compare pain control efficacy, recovery outcomes, and postoperative complications between IV and epidural preemptive analgesia routes in lumbar spine surgeries.

Methods: A prospective, double blinded study comparing the efficacy of intravenous (IV) and epidural preemptive analgesia in patients undergoing lumbar spine surgery. Patients undergoing lumbar spine surgery were divided into three groups based on the analgesia route: Epidural, IV and Control respectively. Pain scores, analgesic consumption, and recovery profiles were assessed postoperatively. Statistical analyses, including ANOVA and Chi-square tests, were used to evaluate differences in pain control and recovery outcomes between groups.

Results: VAS scores at 4, 8, 12, and 24 h postoperatively were significantly different among groups (p < 0.0001). Group 1 (epidural) reported scores of 5.13 ± 0.86, 4.97 ± 0.93, 3.23 ± 0.94, and 3.17 ± 0.91; Group 2 (IV): 6.79 ± 1.29, 5.07 ± 0.92, 3.79 ± 1.18, and 3.21 ± 0.94; Group 3 (control): 8.92 ± 0.84, 6.96 ± 0.84, 5.82 ± 0.81, and 5.55 ± 0.50. Time to first analgesic was 26.00 ± 9.77 min (G1), 25.00 ± 9.82 min (G2), and 10.41 ± 3.51 min (G3) (p < 0.0001). Total 24-hour consumption: fentanyl- G1: 32.20 ± 4.99 mcg, G2: 30.90 ± 8.78, G3: 62.55 ± 12.34; paracetamol- 1.00 ± 0.00, 1.03 ± 0.19, 2.00 ± 0.00 g; ketorolac- 50.00 ± 0.00, 51.72 ± 9.28, 100.00 ± 0.00 mg; tramadol- 45.00 ± 15.26, 49.66 ± 16.58, 73.47 ± 15.08 mg (all p < 0.0001).

Conclusion: This study fills a critical gap by directly comparing IV and epidural pre-emptive analgesia in lumbar spine surgery, providing insights for clinical decision-making. Findings suggest IV analgesia offers comparable pain control to epidural, presenting a safer alternative with fewer procedural risks. Results hold valuable implications for optimizing perioperative care.

Level of evidence: Level IV.

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来源期刊
European Spine Journal
European Spine Journal 医学-临床神经学
CiteScore
4.80
自引率
10.70%
发文量
373
审稿时长
2-4 weeks
期刊介绍: "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe
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