关键词: 静脉自控镇痛, 布比卡因脂质体, 切口局部浸润麻醉, 腰椎后路手术, 术后镇痛

Abstract:

Objective To compare the analgesic effects of sufentanil patient-controlled intravenous analgesia （PCIA） and liposomal bupivacaine incision local infiltration anesthesia （LIA） in the elderly patients undergoing single- or double-segment posterior lumbar surgery， and to provide the basis for selecting postoperative analgesia methods in the elderly patients undergoing lumbar surgery. Methods A total of 124 elderly patients in our hospital scheduled for elective single-or double-segment posterior lumbar surgery under general anesthesia were selected and divided into sufentanil PCIA group （PCIA group） and liposomal bupivacaine incision LIA group （LIA group） in a 1∶1 ratio， with 62 patients in each group. After excluding those who withdrew from the trial midway， 58 patients were finally included in PCIA group and 60 in LIA group. Thirty minutes before the end of surgery， the patients in PCIA group were treated with a analgesia pump regimen of sufentanil 1.5 μg·kg^-1 combined with dexmedetomidine 1.5 μg·kg^-1. At the end of surgery， the patients in LIA group received multi-point bilateral injections along the surgical incision by a spine surgeon using liposomal bupivacaine 266 mg （diluted in 40 mL of saline）. The resting visual analog scale （VAS） pain scores （non-inferiority margin δ=10 mm） at 30 min， 6 h， 24 h， 48 h， and 72 h postoperatively， the incidences of postoperative adverse reactions （such as nausea and vomiting， respiratory depression， pruritus， constipation， dizziness and drowsiness）， the number of postoperative rescue analgesia interventions， anesthesia satisfaction scores at 48 and 72 h postoperatively， postoperative hospital stay， and wound healing status at discharge were recorded. Results From 30 min to 48 h postoperatively， the resting VAS pain scores of the patients in LIA group were higher than those in PCIA group （P<0.001）， while the resting VAS pain scores at 72 h postoperatively in LIA group were lower than those in PCIA group （P<0.001）. At 30 min， 24 h， and 48 h postoperatively， non-inferiority was established， indicating that the analgesic effect of liposomal bupivacaine incision LIA was not inferior to that of sufentanil PCIA. At 6 h postoperatively， non-inferiority was not established. At 72 h postoperatively， the analgesic effect of liposomal bupivacaine incision LIA was superior to that of sufentanil PCIA （P<0.001）. Compared with PCIA group， the incidence of postoperative nausea and vomiting of the patients in LIA group was decreased （P<0.05）. There were no significant differences in the incidences of postoperative dizziness and drowsiness， constipation， respiratory depression， and pruritus between two groups （P>0.05）. Compared with PCIA group， the postoperative hospital stay of the patients in LIA group was shortened（P<0.001）. There were no significant differences in the number of postoperative rescue analgesia interventions or wound healing grade between two groups （P>0.05）. The anesthesia satisfaction scores of the patients in LIA group at 48 and 72 h postoperatively were higher than those in PCIA group （P<0.05）. Conclusion In the elderly patients undergoing single-or double-segment lumbar surgery， the analgesic effect of liposomal bupivacaine incision LIA is not inferior to that of sufentanil PCIA， with a lower incidence of postoperative adverse reactions and higher postoperative analgesia satisfaction scores.

Key words: Patient-controlled intravenous analgesia, Liposomal bupivacaine, Incision local infiltration anesthesia, Posterior lumbar surgery, Postoperative analgesia