青少年特发性脊柱侧弯后路脊柱融合术后患者自控间歇性硬膜外推注与硬膜外输注的前瞻性、随机、双盲研究。
Patient-controlled Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis: Prospective, Randomized, Double-blinded Study.
作者信息
Erdogan Mehmet Ali, Ozgul Ulku, Ucar Muharrem, Korkmaz Mehmet Fatih, Aydogan Mustafa Said, Ozkan Ahmet Selim, Colak Cemil, Durmus Mahmut
机构信息
Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey.
Inonu University, School of Medicine, Department of Orthopedics and Taumatology, Malatya, Turkey.
出版信息
Spine (Phila Pa 1976). 2017 Jun 15;42(12):882-886. doi: 10.1097/BRS.0000000000001937.
STUDY DESIGN
A prospective, randomized, double-blinded study.
OBJECTIVE
The aim of this study was to compare the efficacy and side effects of patient-controlled intermittent bolus epidural analgesia (PCIEA) and patient-controlled continuous epidural analgesia (PCCEA) for postoperative pain control in adolescent idiopathic scoliosis.
SUMMARY OF BACKGROUND DATA
Epidural analgesia is an accepted efficacious and safe procedure for postoperative pain management in scoliosis surgery. However, the PCIEA has not been adequately investigated for postoperative pain control in adolescent idiopathic scoliosis.
METHODS
Forty-seven patients, 8 to 18 years of age, who were undergoing posterior spinal fusion for idiopathic scoliosis were randomized to either the PCIEA or PCCEA group. An epidural catheter was inserted by a surgeon under direct visualization. The PCIEA group received 0.2 mg/mL of morphine, 0.25 mL/kg of morphine bolus, additional doses of 0.25 mL/kg morphine with a 1-hour lockout given by patient-controlled demand, and no infusion. The PCCEA group received the following: 0.2 mg/mL morphine, an initial morphine loading set at 0.1 mL/kg, followed by a 0.05 mL/kg/h continuous infusion of morphine, and a 0.025 mL/kg bolus dose of morphine. There was a 30-minute lockout interval. The primary outcome was morphine usage. The secondary outcomes were pain score, postoperative nausea and vomiting, and pruritus.
RESULTS
Cumulative morphine consumption was lower in the PCIEA group than in the PCCEA group. Both methods provided effective pain control. There were no differences in pain scores between the groups. Postoperative nausea, vomiting, and pruritus were lower in the PCIEA group.
CONCLUSION
The two epidural analgesia techniques studied are both safe and effective methods for postoperative pain control after posterior spinal fusion in idiopathic scoliosis. Nausea, vomiting and pruritus were considerably higher in the PCCEA group. Concerns regarding side effects associated with epidural opioids can be avoided by an intermittent bolus with a relatively lower amount of opioid.
LEVEL OF EVIDENCE
研究设计
一项前瞻性、随机、双盲研究。
目的
本研究旨在比较患者自控间歇性推注硬膜外镇痛（PCIEA）和患者自控持续硬膜外镇痛（PCCEA）在青少年特发性脊柱侧凸术后疼痛控制中的疗效和副作用。
背景数据总结
硬膜外镇痛是脊柱侧凸手术术后疼痛管理中一种公认的有效且安全的方法。然而，PCIEA在青少年特发性脊柱侧凸术后疼痛控制方面尚未得到充分研究。
方法
47例8至18岁接受特发性脊柱侧凸后路脊柱融合术的患者被随机分为PCIEA组或PCCEA组。硬膜外导管由外科医生在直视下插入。PCIEA组接受0.2mg/mL的吗啡，0.25mL/kg的吗啡推注量，患者按需自控给药，每1小时追加0.25mL/kg吗啡，且无持续输注。PCCEA组接受以下处理：0.2mg/mL吗啡，初始吗啡负荷量设定为0.1mL/kg，随后以0.05mL/kg/h的速度持续输注吗啡，并给予0.025mL/kg的吗啡推注剂量。锁定间隔为30分钟。主要结局指标为吗啡用量。次要结局指标为疼痛评分、术后恶心呕吐及瘙痒。
结果
PCIEA组的累积吗啡消耗量低于PCCEA组。两种方法均能有效控制疼痛。两组间疼痛评分无差异。PCIEA组术后恶心、呕吐及瘙痒发生率较低。
结论
所研究的两种硬膜外镇痛技术均是特发性脊柱侧凸后路脊柱融合术后疼痛控制的安全有效方法。PCCEA组恶心、呕吐及瘙痒发生率明显更高。通过使用相对较低剂量阿片类药物的间歇性推注可避免与硬膜外阿片类药物相关的副作用问题。
证据级别
2级。
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