Effect of preemptive analgesia in the treatment of senile osteoporotic vertebral compressed fracture by percutaneous kyphoplasty

doi:10.3877/cma.j.issn.1673-9450.2020.05.010

Abstract

Abstract:

Objective

To evaluate the analgesic effect and safety of preemptive analgesia(PA) model in the treatment of senile osteoporosis vertebra compressed fracture(OVCF) with percutaneous kyphoplasty(PKP).

Methods

A total of 84 patients who conform to the inclusion criteria and were admitted to First Affiliated Hospital of HeBei North University from January 2018 to December 2019 were selected and randomly divided into the PA group and the control group accerding to the random toble method. Both of which were treated with PKP, the pathologic vertebra was injected into bone cement, after via percutaneous puncture and the interventional balloon dilation. The PA group was intramuscular injected with 10 mg Dezocine injection 15 min before the operation, while the control group was not given special treatment before the operation. The visual analogue scale(VAS) score of 4 time points, before operation (T1), trocar puncture (T2), bone cement injection (T3), and 24 h after operation (T4) were recorded in the 2 groups. Recorded the dosage of anesthetics used in the two groups during the operation, and recorded the changes in heart rate and blood pressure of patients at T1, T2 and T3 time points. Adverse drug reactions from T1 time point to T4 time after surgery were recorded. Patients′ satisfaction with the effect of intraoperative pain control were recorded, too. The data was analyzed by t test and chi-square test.

Results

The VAS scores of the two groups at T1 time point were (6.9±0.3), (6.8±0.4) points, and the difference was not statistically significant (t=1.36, P=0.17); the VAS scores of the two groups at T4 time point were (2.2±0.3), (2.4±0.2) points, the difference was not statistically significant (t=1.98, P=0.21); the VAS scores of the two groups at T2 time point were (2.5±0.8), (3.7±0.9) points, the difference was statistically significant (t=3.23, P<0.05); the VAS scores of the two groups at T3 time point were (2.4±0.6), (3.6±0.6) points, the difference was statistically significant (t=3.86, P<0.05). Intraoperative anesthetic dose of PA group(9.1±1.1)mL was significantly lower than that in the control group[(16.6±1.4) mL] (t=4.47, P<0.05). There was no statistically significant difference in heart rate [(92±8), (94±9) times/min] and blood pressure[(1 528/907), (1 559/918) mmHg(1 mmHg=0.133 kPa)] between the two groups at T1 time point (with P values above 0.05), and there were statistically significant differences at T2 and T3 time point (with P values below 0.05). There was no difference in the adverse drug reactions between the two groups from T1 time point to T4 time after surgery (P>0.05). Patients′ satisfaction with the effect of intraoperative pain control was significantly higher in the PA group than in the control group with a difference (χ²=5.48, P<0.05).

Conclusion

It is safe and feasible to perform PA during the operation of PKP in patients with OVCF with good analgesic effect and high patient satisfaction.

Key words: Kyphoplasty, Osteoporosis, Osteoporotic fractures, Aged, Preemptive Analgesia, Curative effect

Guang Xue, Xinming Yang, Ying Zhang. Effect of preemptive analgesia in the treatment of senile osteoporotic vertebral compressed fracture by percutaneous kyphoplasty[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2020, 15(05): 383-388.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhssyxfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9450.2020.05.010

https://zhssyxfzz.cma-cmc.com.cn/EN/Y2020/V15/I05/383

Figures/Tables 5

References 29

[1]	Eastell R, O′neill TW, Hofbauer LC, et al. Postmenopausal osteoporosis[J]. Nat Rev Dis Primers, 2016, 2: 16069.
[2]	Siris ES, Adler R, Bilezikian J, et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group[J]. Osteoporos Int, 2014, 25(5): 1439-1443.
[3]	邱贵兴，裴福兴，胡侦明，等. 中国骨质疏松性骨折诊疗指南(骨质疏松性骨折诊断及治疗原则)[J]. 中华骨与关节外科杂志，2015, 8(5): 371-374.
[4]	Choi SH, Kim DY, Koo JW, et al. Incidence and Management Trends of Osteoporotic Vertebral Compression Fractures in South Korea: A Nationwide Population-Based Study[J]. Asian Spine J, 2020, 14(2): 220-228.
[5]	Pan M, Ge J, Li Q, et al. Percutaneous vertebral augmentation in special Genant IV osteoporotic vertebral compression fractures[J]. J Orthop Translat, 2019, 20: 94-99.
[6]	McCarthy J, Davis A. Diagnosis and Management of Vertebral Compression Fractures[J]. Am Fam Physician, 2016, 94(1): 44-50.
[7]	Wei P, Yao Q, Xu Y, et al. Percutaneous kyphoplasty assisted with/without mixed reality technology in treatment of OVCF with IVC: a prospective study[J]. J Orthop Surg Res, 2019, 14(1): 255-262.
[8]	Zhang L, Wang Q, Wang L, et al. Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures[J]. Clin Interv Aging, 2017, 12: 431-436.
[9]	张瑛，商月娥，杨新明. 超前镇痛在膝关节周围骨折术后病人护理中的应用[J]. 护理研究，2012, 26(32): 3032-3033.
[10]	Aglio LS, Abd-El-Barr MM, Orhurhu V, et al. Preemptive analgesia for postoperative pain relief in thoracolumbosacral spine operations: a double-blind, placebo-controlled randomized trial[J]. J Neurosurg Spine, 2018, 29(6): 647-653.
[11]	Aida S, Yamakura T, Baba H, et al. Preemptive analgesia by intravenous low-dose ketamine and epidural morphine in gastrectomy: a randomized double-blind study[J]. Anesthesiology, 2000, 92(6): 1624-1630.
[12]	Farouk S. Pre-incisional epidural magnesium provides pre-emptive and preventive analgesia in patients undergoing abdominal hysterectomy[J]. Br J Anaesth, 2008, 101(5): 694-699.
[13]	Lee JK, Chung KS, Choi CH. The effect of a single dose of preemptive pregabalin administered with COX-2 inhibitor: a trial in total knee arthroplasty[J]. J Arthroplasty, 2015, 30(1): 38-42.
[14]	Van Backer JT, Jordan MR, Leahy DT, et al. Preemptive Analgesia Decreases Pain Following Anorectal Surgery: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial[J]. Dis Colon Rectum, 2018, 61(7): 824-829.
[15]	Kien NT, Geiger P, Van Chuong H, et al. Preemptive analgesia after lumbar spine surgery by pregabalin and celecoxib：a prospective study[J]. Drug Des Devel Ther, 2019, 13(8): 2145-2152.
[16]	陈翔，邓明，黄晖，等. 全麻或局麻行椎体后凸成型术的疗效对比研究[J]. 蚌埠医学院学报，2012, 37(3): 323-324.
[17]	张加芳，郑召民，钟继平，等. 局麻下经皮椎体后凸成形术术中疼痛的临床研究[J]. 中国骨与关节杂志，2012, 1(1): 38-40.
[18]	孙强，徐杰，邹雪琴，等. 麻醉方式对椎体后凸成形术疗效影响的比较研究[J]. 中国骨质疏松杂志，2010, 16(1): 34-38.
[19]	吴祥，钱列，贾永伟，等. 全身麻醉与局部麻醉应用于经皮椎体后凸成形术的效果比较 [J]. 现代实用医学，2011, 23(11): 1226-1228.
[20]	Liu J, Wang L, Chai M, et al. Analysis of Anesthesia Methods in Percutaneous Kyphoplasty for Treatment of Vertebral Compression Fractures[J]. J Healthc Eng, 2020, 2020: 3965961.
[21]	刘钰，何永恒. 疼痛机制的分子生物学研究进展[J]. 中华中医药学刊，2017, 35(2): 373-377.
[22]	Steinberg AC, Schimpf MO, White AB, et al. Preemptive analgesia for postoperative hysterectomy pain control: systematic review and clinical practice guidelines[J]. Am J Obstet Gynecol, 2017, 217(3): 303-313, e6.
[23]	周宗科，廖刃，唐佩福，等. 中国骨科手术加速康复围手术期疼痛管理指南[J]. 中华骨与关节外科杂志，2019, 12(12): 929-938.
[24]	Rittner HL, Brack A, Stein C. The other side of the medal: how chemokines promote analgesia[J]. Neurosci Lett, 2008, 437(3): 203-208.
[25]	Fichna J, Janecka A, Costentin J, et al. The endomorphin system and its evolving neurophysiological role[J]. Pharmacol Rev, 2007, 59(1): 88-123.
[26]	Machelska H. Dual peripheral actions of immune cells in neuropathic pain[J]. Arch Immunol Ther Exp (Warsz), 2011, 59(1): 11-24.
[27]	Machelska H. Targeting of opioid-producing leukocytes for pain control[J]. Neuropeptides, 2007, 41(6): 355-363.
[28]	李然，许幸. 地佐辛注射液用于缓解术后疼痛的有效性和安全性[J]. 中国临床药理学杂志，2014, 30(1): 3-5.
[29]	Dekan Z, Sianati S, Yousuf A, et al. A tetrapeptide class of biased analgesics from an Australian fungus targets the micro-opioid receptor[J]. Proc Natl Acad Sci USA, 2019, 116(44): 22353-22358.

组别	例数	年龄(岁)	性别(男/女)	体重(kg)	骨密度(g/cm²)	术前VAS评分(分)	手术时间(min)
PA组	42	73.85±6.07	13/29	62.67±4.18	0.712±0.024	6.9±0.3	38.67±4.11
对照组	42	72.45±6.11	11/31	62.93±4.32	0.717±0.035	6.8±0.4	43.69±3.89
χ²/t值		1.21	0.23	0.78	0.40	1.54	1.17
P值		0.23	0.62	0.44	0.68	0.21	0.24

组别	例数	年龄(岁)	性别(男/女)	体重(kg)	骨密度(g/cm²)	术前VAS评分(分)	手术时间(min)
PA组	42	73.85±6.07	13/29	62.67±4.18	0.712±0.024	6.9±0.3	38.67±4.11
对照组	42	72.45±6.11	11/31	62.93±4.32	0.717±0.035	6.8±0.4	43.69±3.89
χ²/t值		1.21	0.23	0.78	0.40	1.54	1.17
P值		0.23	0.62	0.44	0.68	0.21	0.24

组别	例数	T₈	T₉	T₁₀	T₁₁	T₁₂	L₁	L₂	L₃	L₄
PA组	42	1	2	3	5	10	15	3	2	1
对照组	42	1	2	2	4	11	15	4	2	1
χ²值		0.00	0.00	0.21	0.12	0.63	0.00	0.15	0.00	0.00
P值		>0.05	>0.05	0.64	0.72	0.80	>0.05	0.69	>0.05	>0.05

组别	例数	T₈	T₉	T₁₀	T₁₁	T₁₂	L₁	L₂	L₃	L₄
PA组	42	1	2	3	5	10	15	3	2	1
对照组	42	1	2	2	4	11	15	4	2	1
χ²值		0.00	0.00	0.21	0.12	0.63	0.00	0.15	0.00	0.00
P值		>0.05	>0.05	0.64	0.72	0.80	>0.05	0.69	>0.05	>0.05

组别	例数	心率(次/min)			收缩压/舒张压(mmHg)
组别	例数	T1	T2	T3	T1	T2	T3
PA组	42	92±8	82±7	83±8	152±8/90±7	153±3/85±8	153±6/85±9
对照组	42	94±9	108±5	109±6	155±9/91±8	165±6/95±4	169±4/95±5
t值		0.47	3.33	3.51	1.68	3.90	3.98
P值		0.64	<0.05	<0.05	0.11	<0.05	<0.05

Please choose a citation manager

Content to export