腰椎间室阻滞对儿童髋关节手术后的疼痛治疗是否有效？

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详细

论证。髋关节手术是一种创伤很大的外科手术。目前，H. Turner National Medical Research Center使用在腰椎LIII-LIV水平放置导管的长时间硬膜外阻滞或长时间静脉镇痛作为治疗髋关节手术后疼痛综合征的主要方法。同时，直到最近才考虑到长时间腰椎间室阻滞的潜力。

本研究旨在评估在髋关节手术后早期，与传统止痛技术相比，长时间腰椎间室阻滞止痛的疗效。

材料和方法。研究分析了14名儿童在15次髋关节手术后的术后镇痛结果，其中包括3名接受长时间腰椎间室阻滞的患者、9名接受长时间硬膜外阻滞的患者和3名接受全身镇痛药术后镇痛的患者。在这14名患者中，1名患有双侧先天性髋关节脱位的患者在第一次手术后接受了长时间的腰椎间室阻滞麻醉，在另一条腿的第二次手术后接受了长时间的硬膜外阻滞麻醉。镇痛效果采用Wong-Baker量表、FLACC行为量表和视觉模拟量表进行评估。

结果。所有三名患者在使用延长腰椎间室阻滞时，始终需要额外注射酒石酸布托啡诺（曲马尔）以获得良好的镇痛效果。在使用长时间硬膜外阻滞时，则无需额外使用阿片类镇痛药。

结论。由于继续需要在延长硬膜外阻滞的情况下使用酒石酸布托啡诺，因此认为不宜在髋关节手术后的术后早期使用延长腰椎间室阻滞来缓解儿童的疼痛。

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作者简介

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN 代码: 7125-4930

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

俄罗斯联邦, Saint Petersburg

Viktor A. Koriachkin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN 代码: 6101-0578

MD, PhD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Dmitry V. Zabolotskii

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Email: zdv4330303@gmail.com
ORCID iD: 0000-0002-6127-0798
SPIN 代码: 6726-2571
俄罗斯联邦, Saint Petersburg; Saint Petersburg

Rustam R. Safin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Federal State Kazan (Volga) University

编辑信件的主要联系方式.
Email: safin_r.r@hotmail.com
ORCID iD: 0000-0003-0960-7426
SPIN 代码: 7464-7151

MD, PhD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg; Kazan

Pavel I. Bortulev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN 代码: 9903-6861

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Tamila V. Baskaeva

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
SPIN 代码: 5487-4230

MD, orthopedic and trauma surgeon

俄罗斯联邦, Saint Petersburg

Mikhail N. Dolgopolskii

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: mdolgopolsky@gmail.com
ORCID iD: 0000-0001-7690-2340

MD, anesthesiologist and intensivist

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Clinical case 2 (patient 2): contrasting the fascial case of the psoas major muscle

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3. Fig. 2. Patient 3: a, withdrawal of the needle slice from the lumbar plexus; b, catheterization of the lumbar compartment. Ultrasonographic landmarks in the axial scanning plane at the level of the LIV–V vertebrae (linear transducer, 14 MHz): Corp. L4, body of the IV lumbar vertebra; M. ES, back erector muscle; M. PM, large lumbar muscle; M. QL, quadratus lumborum muscle; Pl. Lumb (L1–4), lumbar plexus at the LIV–V level of the ultrasonographic slice; Pr. Tr L4, transverse process of the IV lumbar vertebra

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4. Fig. 3. Patient 3: a, with bilateral hip dislocation (clinical case 3); b, after the first stage of surgical treatment (clinical case 3); c, after the second stage of surgical treatment (clinical case 4)

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