| Objective to study the effect of multimodal analgesia combining methylprednisolone, parecoxib and ropivacaine for the improvement of surgical clinical outcomes, decrement of morphine, and promotion of functional restoration in patients undergoing posterior spine surgery.Methods A randomized, double-blind, placebo-controlled experiments was conducted by selecting 40 patients as research object, which come from the spine department of second affiliated hospital of dalian medical university from the September to December in 2014. The patients were scheduled into the trial group and control group randomly(20 patients each group), and respectively received posterior lumbar discectomy, decompressive laminectomy, intervertebral bone graft fusion. The treatment group received 40 mg intravenous parecoxib at the start of the operation, a piece of autologous fat taken from the wound was first soaked in 10-m L(80 mg) of methylprednisolone and placed over the exposed nerve root following discectomy, and 80 mg steroid and 0.2% ropivacaine 30 ml was flushed into the wound at closure. While the control group was left untreated.Within 48 hours after surgery, all patients were connected to a patient-controlled analgesia pump(PCA). After 48 hours the analgesia treatment of oral acetaminophen oxycodone substituted for PCA and give additional intramuscular Ketorolac Tromethamine when necessary. We evaluated the effect of multimodal analgesia for postoperative clinical outcome of patients through the visual analog pain score(VAS) after operation, Oswestry disability index in 1 week, 3 month after operation, consumption the side effects of morphine within 48 hours after surgery..Results After statistics analysis, the basic characteristics of the patients in the two groups have no significant difference. The cumulative dose and side effects of morphineare within 48 hours after operation in trial group were significantly lower than that in the control group(p < 0.05). The percentage difference of morphineare dose between this two groups was ever-increasing in the first 24 hours after operation. However, this difference was declined in the rest of 48 hours after operation. This difference was most significant in the first hour after operation. The mean value of VAS at this time in the trial group and control group was respectively 4.65+1.18 and 6.75+0.97(p=0.001), the mean value of VAS was reduced by 31% in the trial group compared with the control group. On the other hand, the mean value of VAS 48 hours after operation in the trial group and control group was respectively 2.10+0.64 and 2.50+0.51(p=0.036), and the percentage difference between this two groups was 16%. Postoperatively 1 week to 3 months, the mean VAS score of lumbocrural pain and Oswestry disability index in trial group were significantly lower than that in the control group. The VAS score of back pain 1 week after operation in the trial group was respectively 1.30+1.47, which was reduced by 35% compared with the control group(2.00+0.56)(p=0.001). The VAS score of leg pain 1 week after operation in the trial group was respectively 1.40+0.50, which was reduced by 41%, compared with the control group(2.40+1.50)(p=0.001). The Oswestry disability index one month after operation in the trial group and control group was respectively 20.85+1.39 and 22.60+1.05(p=0.001), the former was reduced by 5% compared with the latter. Further, there is no statistically significant difference of back and leg VAS score and Oswestry disability index between trial group and control group 3 months after surgery(P > 0.05).Conclusions methylprednisolone--parecoxib--ropivacaine of multim- odal analgesia can effectively relieve the symptoms of back and leg pain, reduce the cumulative dose of opioids and its side effects significantly, promote postoperative function restoration of patients receiveing spinal posterior surgery. |
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