经皮/内镜经椎间孔腰椎体间融合术后行胸腰筋膜平面阻滞可实现阿片类药物-free 术后康复。

Thoracolumbar Interfascial Plane Block Results in Opioid-Free Postoperative Recovery After Percutaneous/Endoscopic Transforaminal Lumbar Interbody Fusion Surgery.

机构信息

Morgenstern Institute of Spine, Centro Médico Quirón Teknon, Barcelona, Spain.

Central Anesthesiology Service, Centro Médico Quirón Teknon, Barcelona, Spain.

出版信息

World Neurosurg. 2021 Sep;153:e473-e480. doi: 10.1016/j.wneu.2021.06.152. Epub 2021 Jul 6.

DOI:10.1016/j.wneu.2021.06.152

PMID:34242827

Abstract

OBJECTIVE

To evaluate efficacy in reducing postoperative pain and opioid analgesia of a novel interdisciplinary strategy combining preoperative thoracolumbar interfascial plane (TLIP) block and percutaneous/endoscopic transforaminal lumbar interbody fusion surgery and to determine time to first postoperative ambulation and hospital length of stay.

METHODS

In this retrospective review, 42 patients who underwent elective single-level percutaneous/endoscopic transforaminal lumbar interbody fusion surgery between 2015 and 2021 were divided into 2 groups: TLIP group with 17 patients who underwent TLIP block and non-TLIP group with 25 patients. Both groups received the same postoperative analgesia with morphine as patient-controlled rescue medication. Visual analog scale and Oswestry Disability Index scores were evaluated. Statistical evaluation was performed with Student t test.

RESULTS

In contrast to the non-TLIP group, in the TLIP group, postoperative mean visual analog scale back score and mean Oswestry Disability Index score significantly decreased from 6.6 to 3.3 (P < 0.01) and 32.8 to 23.6 (P < 0.01), respectively, at hospital discharge. No differences were found between the groups at 1 month. Overall mean follow-up time was 29 ± 18 months (range, 3-78 months). Patients in the non-TLIP group were administered a median postoperative 24-hour morphine dose equivalent of 23 mg (range, 8-31 mg), while patients in the TLIP group did not require opioid analgesia (P < 0.01). Patients in the TLIP group started postoperative ambulation at a median of 4.1 hours (range, 2.5-26 hours) with a median hospital length of stay of 24 hours (range, 20-48 hours) (P = 0.112).

CONCLUSIONS

TLIP block significantly improves patient outcome at hospital discharge after transforaminal lumbar interbody fusion surgery without postoperative administration of opioids. A prospective study is recommended to confirm our preliminary results.

摘要

目的

评估术前胸腰椎筋膜平面（TLIP）阻滞联合经皮/经皮内镜经椎间孔腰椎体间融合术的新的跨学科策略在减少术后疼痛和阿片类镇痛药方面的疗效，并确定首次术后活动和住院时间。

方法

在这项回顾性研究中，将 2015 年至 2021 年间接受选择性单节段经皮/经皮内镜经椎间孔腰椎体间融合术的 42 例患者分为两组：TLIP 组 17 例，TLIP 阻滞组；非 TLIP 组 25 例。两组均采用吗啡作为患者自控解救药物进行相同的术后镇痛。评估视觉模拟评分和 Oswestry 残疾指数评分。采用学生 t 检验进行统计学评价。

结果

与非 TLIP 组相比，TLIP 组术后平均视觉模拟评分背部评分和平均 Oswestry 残疾指数评分分别从 6.6 分降至 3.3 分（P < 0.01）和 32.8 分降至 23.6 分（P < 0.01），在出院时。两组在 1 个月时无差异。总体平均随访时间为 29 ± 18 个月（范围 3-78 个月）。非 TLIP 组患者术后 24 小时吗啡剂量中位数为 23 毫克（范围 8-31 毫克），而 TLIP 组患者无需阿片类药物镇痛（P < 0.01）。TLIP 组患者术后平均 4.1 小时（范围 2.5-26 小时）开始活动，平均住院时间为 24 小时（范围 20-48 小时）（P = 0.112）。