Abstract：
OBJECTIVE: To explore preemptive analgesic effect of preoperative intramural tramadol injection in percutaneous kyphoplasty (PKP) of vertebrae following local anesthesia.
METHODS: From August 2019 to June 2021, 118 patients with thoraco lumbar osteoporotic fractures were treated and divided into observation group and control group, with 59 patients in each gruop. In observation group, there were 26 males and 33 females, aged from 57 to 80 years old with an average of (67.69±4.75)years old;14 patients on T11, 12 patients on T12, 18 patients on L1, 15 patients on L2;tramadol with 100 mg was injected intramuscularly half an hour before surgery in observation group. In control group, there were 24 males and 35 females, aged from 55 to 77 years old with an average of (68.00±4.43) years old;19 patients on T11, 11 patients on T12, 17patients on L1, 12 patients on L2;the same amount of normal saline was injected intramuscularly in control group. Observation indicators included operation time, intraoperative bleeding, visual analogue scale (VAS) evaluation and recording of preoperative (T0), intraoperative puncture(T1), and working cannula placement (T2) between two groups of patients, at the time of balloon dilation (T3), when the bone cement was injected into the vertebral body (T4), 2 hours after the operation (T5), and the pain degree at the time of discharge(T6);adverse reactions such as dizziness, nausea and vomiting were observed and recorded;the record the patient\'s acceptance of repeat PKP surgery.
RESULTS: All patients were successfully completed PKP via bilateral pedicle approach, and no intravenous sedative and analgesic drugs were used during the operation. There was no significant difference in preoperative general data and VAS(T0) between two groups (P>0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). VAS of T1, T2, T3, T4 and T5 in observation group were all lower than those in control group(P<0.05), and there was no significant difference in T6 VAS (P>0.05). T6 VAS between two groups were significantly lower than those of T0, and the difference was statistically significant (P<0.05). There was no significant difference in incidence of total adverse reactions between two groups (P>0.05). There was a statistically significant difference in the acceptance of repeat PKP surgery (P<0.05).
CONCLUSIONS: Half an hour before operation, intramuscular injection of tramadol has a clear preemptive analgesic effect for PKP of single-segment thoracolumbar osteoporotic fracture vertebral body under local anesthesia, which could increase the comfort of patients during operation and 2 hours after operation, and improve patients satisfaction with surgery.
METHODS: From August 2019 to June 2021, 118 patients with thoraco lumbar osteoporotic fractures were treated and divided into observation group and control group, with 59 patients in each gruop. In observation group, there were 26 males and 33 females, aged from 57 to 80 years old with an average of (67.69±4.75)years old;14 patients on T11, 12 patients on T12, 18 patients on L1, 15 patients on L2;tramadol with 100 mg was injected intramuscularly half an hour before surgery in observation group. In control group, there were 24 males and 35 females, aged from 55 to 77 years old with an average of (68.00±4.43) years old;19 patients on T11, 11 patients on T12, 17patients on L1, 12 patients on L2;the same amount of normal saline was injected intramuscularly in control group. Observation indicators included operation time, intraoperative bleeding, visual analogue scale (VAS) evaluation and recording of preoperative (T0), intraoperative puncture(T1), and working cannula placement (T2) between two groups of patients, at the time of balloon dilation (T3), when the bone cement was injected into the vertebral body (T4), 2 hours after the operation (T5), and the pain degree at the time of discharge(T6);adverse reactions such as dizziness, nausea and vomiting were observed and recorded;the record the patient\'s acceptance of repeat PKP surgery.
RESULTS: All patients were successfully completed PKP via bilateral pedicle approach, and no intravenous sedative and analgesic drugs were used during the operation. There was no significant difference in preoperative general data and VAS(T0) between two groups (P>0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). VAS of T1, T2, T3, T4 and T5 in observation group were all lower than those in control group(P<0.05), and there was no significant difference in T6 VAS (P>0.05). T6 VAS between two groups were significantly lower than those of T0, and the difference was statistically significant (P<0.05). There was no significant difference in incidence of total adverse reactions between two groups (P>0.05). There was a statistically significant difference in the acceptance of repeat PKP surgery (P<0.05).
CONCLUSIONS: Half an hour before operation, intramuscular injection of tramadol has a clear preemptive analgesic effect for PKP of single-segment thoracolumbar osteoporotic fracture vertebral body under local anesthesia, which could increase the comfort of patients during operation and 2 hours after operation, and improve patients satisfaction with surgery.
摘要：
目的：探讨术前肌壁内注射曲马多在椎体后凸成形术(PKP)中的超前镇痛效果。
方法：选取2019年8月至2021年6月收治的胸腰椎骨质疏松性骨折患者118例，分为观察组和对照组。每个小组有59名患者。在观察组中,有26名男性和33名女性，年龄57～80岁,平均(67.69±4.75)岁;T11组14例,T12组12例,L1组18例,L2组15例;术前半小时肌注曲马多100mg。在对照组中，有24名男性和35名女性，年龄55~77岁，平均(68.00±4.43)岁；T11期19例，T12期11例，L1期17例，L2期12例；对照组肌肉注射等量生理盐水。观察指标包括手术时间、术中出血,视觉模拟评分（VAS）评估和记录术前（T0），术中穿刺（T1），和两组患者之间的工作套管放置（T2），在球囊扩张时（T3），当骨水泥注入椎体（T4），手术后2小时（T5），和疼痛程度在出院时（T6）;不良反应如头晕，观察并记录患者恶心呕吐情况;记录患者接受再次PKP手术的情况。
结果：所有患者均通过双侧椎弓根入路成功完成PKP，术中未使用静脉镇静和镇痛药物。两组患者术前一般资料及VAS(T0)比较差异无统计学意义(P>0.05)。两组手术时间、术中出血量比较,差异无统计学意义(P>0.05)。观察组T1、T2、T3、T4、T5的VAS评分均低于对照组(P<0.05)。T6VAS无显著性差异(P>0.05)。T6两组患者的VAS评分明显低于T0组,差异有统计学意义(P<0.05)。两组总不良反应发生率比较差异无统计学意义(P>0.05)。重复PKP手术的接受度差异有统计学意义(P<0.05)。
结论：手术前半小时，曲马多肌肉注射对局部麻醉下单节段胸腰椎骨质疏松性骨折椎体PKP有明显的超前镇痛作用,这可以增加患者在手术期间和手术后2小时的舒适度，提高患者对手术的满意度。
方法：选取2019年8月至2021年6月收治的胸腰椎骨质疏松性骨折患者118例，分为观察组和对照组。每个小组有59名患者。在观察组中,有26名男性和33名女性，年龄57～80岁,平均(67.69±4.75)岁;T11组14例,T12组12例,L1组18例,L2组15例;术前半小时肌注曲马多100mg。在对照组中，有24名男性和35名女性，年龄55~77岁，平均(68.00±4.43)岁；T11期19例，T12期11例，L1期17例，L2期12例；对照组肌肉注射等量生理盐水。观察指标包括手术时间、术中出血,视觉模拟评分（VAS）评估和记录术前（T0），术中穿刺（T1），和两组患者之间的工作套管放置（T2），在球囊扩张时（T3），当骨水泥注入椎体（T4），手术后2小时（T5），和疼痛程度在出院时（T6）;不良反应如头晕，观察并记录患者恶心呕吐情况;记录患者接受再次PKP手术的情况。
结果：所有患者均通过双侧椎弓根入路成功完成PKP，术中未使用静脉镇静和镇痛药物。两组患者术前一般资料及VAS(T0)比较差异无统计学意义(P>0.05)。两组手术时间、术中出血量比较,差异无统计学意义(P>0.05)。观察组T1、T2、T3、T4、T5的VAS评分均低于对照组(P<0.05)。T6VAS无显著性差异(P>0.05)。T6两组患者的VAS评分明显低于T0组,差异有统计学意义(P<0.05)。两组总不良反应发生率比较差异无统计学意义(P>0.05)。重复PKP手术的接受度差异有统计学意义(P<0.05)。
结论：手术前半小时，曲马多肌肉注射对局部麻醉下单节段胸腰椎骨质疏松性骨折椎体PKP有明显的超前镇痛作用,这可以增加患者在手术期间和手术后2小时的舒适度，提高患者对手术的满意度。
