普瑞巴林联合甲钴胺对腰椎手术术后急性疼痛的影响

doi:10.3969/j.issn.1000-8535.2020.05.018

摘要/Abstract

摘要： 目的观察普瑞巴林联合甲钴胺对腰椎手术术后急性疼痛的影响。方法按照纳入排除标准选择2019年1月—2019年12月在我院行单一节段的腰椎手术患者共60例,缝皮时常规予0.375%罗哌卡因20 mL切口周围浸润,术后使用病人静脉自控镇痛(Patient-Controlled Intravenous Analgesia, PCIA)。患者随机分为2组,实验组:术前1天开始口服普瑞巴林75 mg bid和静脉注射甲钴胺注射液 0.5 mg qd,共5天;对照组:术前1天开始口服普瑞巴林 75 mg bid和注射等体积的生理盐水,共5天。观察术前和术后6、12、24、48 h的VAS评分,在术前、术后24 h和术后48 h进行JOA评分,记录术后24 h和48 h阿片类药物用量、PCIA按压次数、补救用药量和不良反应。结果两组患者术后12 h内的VAS评分无差异,但是在12～48 h这段时间里实验组的静息VAS和运动VAS评分均低于对照组(P<0.05)。实验组在术后24 h和48 h舒芬太尼消耗量、PCIA按压次数和平均补救用药剂量少于对照组(P<0.05),两组患者的JOA评分和不良反应均无差异(P>0.05)。结论普瑞巴林联合甲钴胺应用于腰椎手术患者术后镇痛效果良好,药物不良反应发生率低,但仍需进行更大规模的随机对照研究证实该镇痛方案的安全性和有效性。

关键词: 普瑞巴林, 甲钴胺, 术后急性疼痛, 腰椎

Abstract: Objective To observe the effect of pregabalin combined with mecobalamin on acute pain after lumbar surgery. Methods A total of 60 patients underwent single lumbar spine surgery in our hospital from January 2019 to December 2019. The incisions of patients were routinely infiltrated around the incision with 0.375% ropivacaine 20 mL. Patient-controlled intravenous analgesia (PCIA) was used. The patients were randomly divided into two groups. The experimental group: oral pregabalin 75mg bid and intravenous mecobalamin injection 0.5mg qd 1 day before surgery, five days in total. Control group: oral pregabalin 75mg bid and intravenous injection of equal volume of saline 1 day before surgery, five days in total. The VAS scores of preoperative and postoperative 6, 12, 24, and 48 h were observed. JOA scores were performed before surgery, 24 h after surgery, and 48 h after surgery. The doses of opioids, PCIA pressing times, remedial medications and adverse reactions were recorded at 24 h and 48 h after surgery. Results There was no significant difference in VAS scores between the two groups within 12 h after surgery, but the resting VAS and exercise VAS scores in the experimental group were lower than those in the control group during the period of 12～48 h (P<0.05). The amount of sufentanil, the pressing times of PCIA and the average remedial medication in the experimental group were lower than those in the control group at 24 h and 48 h after operation (P<0.05). There were no significant differences in JOA scores and adverse reactions between the two groups (P>0.05). Conclusion Pregabalin combined with mecobalamin in patients with lumbar spine surgery has good postoperative analgesia and low incidence of adverse drug reactions, but more randomized controlled trials are needed to confirm the safety and efficacy.

Key words: Pregabalin, Mecobalamin, Postoperative acute pain, Lumbar vertebra

黄玉侥. 普瑞巴林联合甲钴胺对腰椎手术术后急性疼痛的影响[J]. 广州医药, 2020, 51(5): 79-83.

HUANG Yuyao. Effect of pregabalin combined with mecobalamin on acute pain after lumbar surgery[J]. Guangzhou Medical Journal, 2020, 51(5): 79-83.

参考文献

[1] VOS T, ALLEN C, ARORA M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 [J]. Lancet, 2016, 388(10053): 1545-1602.
[2] KIEN N T, GEIGER P, van CHUONG H,et al. Preemptive analgesia after lumbar spine surgery by pregabalin and celecoxib: a prospective study [J]. Drug Des Dev Ther, 2019, 2019(13):2145-2152.
[3] CORONADO R A, GEORGE S Z, DEVIN C J,et al. Pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery [J]. Arch Phys Med Rehab, 2015, 96(10): 1763-1770.
[4] DEVIN C J, MCGIRT M J. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes [J]. J Clin Neurosci, 2015, 22(6): 930-938.
[5] YU Y, LIU N, ZENG Q,et al. The efficacy of pregabalin for the management of acute and chronic postoperative pain in thoracotomy: a meta-analysis with trial sequential analysis of randomized-controlled trials [J]. J Pain Res, 2019, 2019(12):159-170.
[6] MAURO G L, MARTORANA U, CATALDO P,et al. Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study [J]. Eur Rev Med Pharmacol Sci, 2000, 4(3): 53-58.
[7] SOLOMON L R. Functional vitamin B12 deficiency in advanced malignancy: implications for the management of neuropathy and neuropathic pain [J]. Support Care Cancer, 2016, 24(8): 3489-3494.
[8] ABI-HANNA D, KERFERD J, PHAN K,et al. Lumbar disk arthroplasty for degenerative disk disease: literature review [J]. World Neurosurg, 2018, 2018(109):188-196.
[9] PUVANESARAJAH V, LIAUW J A, LO S F,et al. Analgesic therapy for major spine surgery [J]. Neurosurg Rev, 2015, 38(3): 407-418.
[10] SCHOENFELD A J, NWOSU K, JIANG W,et al. Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients [J]. J Bone Joint Surg Am, 2017, 99(15): 1247-1252.
[11] KURD M F, KREITZ T, SCHROEDER G,et al. The role of multimodal analgesia in spine surgery [J]. J AM Acad Orthop Sur, 2017, 25(4): 260-268.
[12] CHOU R, GORDON D B, de LEON-CASASOLA O A,et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council [J]. J Pain, 2016, 17(2): 131-157.
[13] KISSIN I. Preemptive analgesia [J]. Anesthesiol, 2000, 93(4): 1138-1143.
[14] SAVITHA K S, DHANPAL R, KOTHARI A N. The effect of multimodal analgesia on intraoperative morphine requirement in lumbar spine surgeries [J]. Anesth Essays Res, 2017, 11(2): 397-400.
[15] LIU B, LIU R, WANG L. A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery [J]. Med, 2017, 96(37): e8031.
[16] CANOS A, CORT L, FERNANDEZ Y,et al. Preventive analgesia with pregabalin in neuropathic pain from "failed back surgery syndrome": assessment of sleep quality and disability [J]. Pain Med, 2016, 17(2): 344-352.
[17] GIANESELLO L, PAVONI V, BARBONI E,et al. Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery [J]. J Neurosurg Anesthesiol, 2012, 24(2): 121-126.
[18] 李柱海, 曾建成, 聂鸿飞, 等. 普瑞巴林联合塞来昔布治疗腰椎间盘突出症经皮内镜术后神经病理性疼痛的疗效观察 [J]. 中国修复重建外科杂志, 2017, 31(2): 215-221.
[19] VASIGH A, JAAFARPOUR M, KHAJAVIKHAN J,et al. The effect of gabapentin plus celecoxib on pain and associated complications after laminectomy [J]. J Clin Diagn Res, 2016, 10(3): 4-8.