超声指导的表面椎块用于下头骨切除后的持续性疼痛:一项随机试验
Min Zeng1, Maoyao Zheng1, Yue Ren1
1Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Anesthesiology
|September 23, 2024
概括
在手术前的超声波导向的表面椎块显著降低了下骨切除术后3个月的持续疼痛. 这种干预为改善患者康复和管理术后疼痛提供了一个有希望的策略.
科学领域:
- 麻醉学和疼痛管理
- 神经外科 神经外科
- 区域麻醉 区域麻醉
背景情况:
- 切除术后持续的疼痛是一个重大的临床挑战.
- 表面交积块 (SCPB) 缓解手术后疼痛的疗效尚未得到充分证实.
- 这项研究研究了SCPB在减轻下骨切割后的慢性疼痛中的作用.
研究的目的:
- 为了确定手术前的超声波导向的表面宫结阻断是否会在下头骨切除术后3个月减少持续的疼痛.
- 为了评估持续的切口疼痛的发病率,在患者进行下头骨骨切割术.
主要方法:
- 一个单中心的,随机的,盲目的,平行组试验.
- 292名接受头骨下切割的患者被随机分配给接受超声波引导的SCPB与0.5%的罗皮瓦卡因或液安慰剂.
- 主要结局是手术后3个月内持续疼痛的发生率.
主要成果:
- 与盐水组相比,接受罗皮瓦卡因SCPB的患者在3个月内报告的持续性疼痛显著减少 (34%与51%在每个协议中;36%与53%在治疗意图中).
- 在罗皮瓦卡因组,持续性疼痛的相对风险降低了大约三分之一 (RR 0.66;P=0.003 per-protocol;RR 0.69;P=0.005 intention-to-treat).
- 患者的平均年龄为45±12岁,平均手术持续时间为4.2±1.3小时.
结论:
- 手术前的超声波导向的表面椎结质阻塞有效地减少了下头骨切除术后持续的切口疼痛的发生率.
- 在神经外科患者的疼痛管理中,SCPB代表了一个有价值的辅助.
- 这种技术提供了一种潜在的方法来减少慢性疼痛,并改善接受特定部手术的患者的治疗结果.
更多相关视频
相关概念视频
Spinal Nerves: Plexus I
797
Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...
797
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
377
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
377
Local Anesthetics: Clinical Application as Spinal Anesthesia
591
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
591
Local Anesthetics: Clinical Application as Epidural Anesthesia
421
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
421
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
987
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
987
Depolarizing Blockers: Pharmocokinetics
315
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
315


