纳洛酮胸腰筋膜平面阻滞在TLIF术后镇痛效果

Analgesic effect of naloxone in thoracolumbar interfascial plane block during perioperative period of transforaminal lumbar interbody fusion

摘要:

[目的]探讨小剂量纳洛酮胸腰筋膜平面（thoracolumbar interfascial plane, TLIP）阻滞在经椎间孔腰椎椎体间融合术 （transforaminal lumbar interbody fusion, TLIF） 术后的镇痛效果。[方法] 2020 年 5 月—2023 年 5 月腰椎退行性疾病在全麻下行 TLIF 的 82 例患者纳入本研究。根据术前医患沟通结果，40 例采用常规 TLIP 阻滞 （常规组），另外 42 例采用小剂量纳洛酮 TLIP 阻滞（纳洛酮组），比较两组围手术期临床与镇痛资料。[结果]两组手术时间、术中出血量和不良反应发生率差异无统计学意义 （P＞0.05）。两组术后 2~48 h VAS 评分均先上升后下降，但纳洛酮组 6、24、48 h 的 VAS 评分均显著低于常规组 （P＜ 0.05）。此外，纳洛酮组在首次补救镇痛 [(10.5±1.8) h vs (6.4±1.6) h, P＜0.001]、PCIA 按压次数 [(6.4±0.9) 次 vs (8.1±1.5) 次, P＜ 0.001]、舒芬太尼剂量 [(72.6±14.6) μg vs (84.5±17.6) μg, P=0.001]、额外镇痛次数 [(1.2±0.4) 次 vs (1.8±0.2) 次, P＜0.001] 均显著优于常规组。[结论]小剂量纳洛酮 TLIP 阻滞能够有效缓解 TLIF 术后早期疼痛症状，减少术后镇痛药物使用量及次数。

Abstract:

[Objective] To investigate the clinical outcomes of low-dose naloxone in thoracolumbar interfascial plane (TLIP) block during perioperative period of transforaminal lumbar interbody fusion (TLIP). [Methods] A total of 82 patients who were undergoing TLIF under general anesthesia for lumbar degenerative diseases from May 2020 to May 2023 were included in this study. According to the preoperative doctor-patient communication, 40 patients received conventional TLIP block (conventional group), while other 42 cases received low-dose naloxone in TLIP block (naloxone group). The perioperative clinical and analgesic data of the two groups were compared. [Results] There were no significant differences in operation time, intraoperative blood loss, incidence of adverse reactions between the two groups (P＞0.05). The VAS scores in both groups increased firstly and then decreased in the period from 2 hours to 48 hours after surgery. However, the naloxone group was marked significantly lower VAS scores 6, 24 and 48 hours than the conventional group (P＜0.05). In addition, the naloxone group proved significantly superior to the conventional group in terms of the time of the first remedial analgesia use [(10.5±1.8) hours vs (6.4± 1.6) hours, P＜0.001], the number of PCIA press [(6.4±0.9) times vs (8.1±1.5) times, P＜0.001], sufentanil doses [(72.6±14.6) μg vs (84.5± 17.6) μg, P=0.001], and the number of additional analgesia [(1.2±0.4) times vs (1.8±0.2) times, P＜0.001]. [Conclusion] TLIP block with low-dose naloxone can effectively relieve early pain symptoms, and reduce the use and frequency of postoperative analgesics during perioperative period of TLIF.