【摘要】 [目的]探讨辅助椎间孔周围浸润麻醉对经皮腰椎间孔镜髓核摘除术中镇痛的疗效。[方法]将64例单节段腰椎间孔镜下髓核摘除术治疗的患者随机分为椎间孔浸润组和逐层浸润组。椎间孔浸润组于棘突旁开约4 cm予0.5%利多卡因行关节突外侧及椎间孔浸润麻醉;逐层浸润组采用逐层利多卡因浸润麻醉。记录两组手术时间、透视次数,采用视觉模拟评分法(visual analogue scale,VAS)评估椎间孔成形及后纵韧带处理时的疼痛,采用Likert五分量表法评价患者对局麻手术的体验,并对再手术意愿进行调查。[结果]椎间孔浸润组患者均顺利完成手术,逐层浸润组有3例术中在椎间孔成形时由于不能耐受疼痛而临时增加静脉强化镇痛;两组手术时间、透视次数差异不具有统计学意义(P>0.05);椎间孔浸润组椎间孔成形VAS评分为(4.74±1.05)分,逐层浸润组(7.48±1.16)分,差异有统计学意义(P<0.05)。后纵韧带处理时椎间孔浸润组VAS评分(3.74±0.62)分,逐层浸润组(5.22±0.80)分,差异具有统计学意义(P<0.05);椎间孔浸润组的局麻体验评价选择好和很好的占75.00%,而逐层浸润组仅31.25%;再手术意愿椎间孔浸润组为87.00%,而逐层浸润组为46.88%,差异具有统计学意义(P<0.05)。[结论]辅助椎间孔周围浸润麻醉可以显著减少椎间孔镜术中的疼痛,且操作简单,安全性高。更多还原

【Abstract】 [Objective] To investigate the analgesic effects of supplemental infiltration anesthesia around foramen in percutaneous transforaminal endoscopic discectomy(PTED). [Methods] Sixty-four patients with single-segment lumbar disc herniation treated by PTED were randomly divided into the trial group and control group. The patients in the control group received layer-by-layer infiltration anesthesia with 0.5% lidocaine, while the patients in the trial group were added supplemental infiltration anesthesia to the lateral facet joint and foramina with 0.5% lidocaine. The operative time and fluoroscopy frequency were recorded. Visual analog scale(VAS) was used to assess of pain extent of foraminoplasty and posterior longitudinal ligament handling in surgery. In addition, 5-point Likert-type scale was used for evaluation of patient s experience to local anesthesia and tolerance to re-operation was assessed as well. [Results] All the patients in the trial group underwent the procedure smoothly,whereas 3 patients in the control group had to add intensive intravenous analgesia temporarily due to intolerance to the pain.There was no significant difference of operative time and fluoroscopy frequencies between two groups(P>0.05). The VAS during foraminoplasty was 4.74±1.05 in the trial group, while 7.48±1.16 in the control group(P<0.05), additionally, VAS during posterior longitudinal ligament handling was 3.74±0.62 versus 5.22±0.80(P<0.05). In term of subjective experience to the local anesthetics, 75% patients in the trial group reported positively, while 31.3% in the control group(P<0.05). In addition, Patient reported tolerance to re-operation was 87.5% in the trial versus 46.9% in the control(P<0.05). [Conclusion] Supplemental infiltration anesthesia around foramen can significantly reduce pain in PTED, associated with simple manipulation and high safety.更多还原