RÉSUMÉ
Objective:To compare the efficacy of dexmedetomidine combined with sufentanil versus oxycodone for percutaneous transforaminal endoscopic surgery. Methods:Eighty patients with lumbar disc herniation undergoing percutaneous transforaminal endoscopic discectomy, aged 18-65 yr, were selected and divided into 2 groups ( n=40 each) according to the random number table method: dexmedetomidine combined with sufentanil group and dexmedetomidine combined with oxycodone group. Dexmedetomidine was given as a loading dose of dexmedetomidine 0.8 μg/kg (10-15 min) before surgery, followed by an intravenous infusion of 0.4-0.6 μg/kg until 10 min before the end of surgery. At 5 min before surgery, sufentanil was intravenously injected as a bolus of 0.1 μg/kg, followed by an intravenous infusion of 0.1 μg/kg until 10 min before the end of surgery in dexmedetomidine combined with sufentanil group, and oxycodone was intravenously injected as a bolus of 0.05 μg/kg, followed by an intravenous infusion of 0.05 mg/kg until 10 min before the end of surgery in dexmedetomidine combined with oxycodone group. The Ramsay sedation score, mean arterial pressure and heart rate were recorded before administration, before skin incision, at 10 min after the start of surgery, at polishing facet joints and at the end of surgery. Bispectral index value was also recorded before skin incision, at 10 min after the start of surgery, at polishing facet joints and at the end of surgery. The emergence time was recorded, and the emergence quality was evaluated using Steward score. The visual analog scale score was recorded before surgery and at 1, 6 and 24 h after surgery. Peripheral venous blood samples were taken before administration and at 1 h after surgery for determination of concentrations of serum angiotensin Ⅱ and endothelin by radioimmunoassay. The perioperative adverse reactions were recorded. Results:Compared with dexmedetomidine combined with sufentanil group, the Ramsay sedation score before skin incision, at 10 min after the start of surgery, at polishing facet joints and at the end of surgery was significantly increased, and the mean arterial pressure, heart rate and bispectral index value were decreased, and the visual analog scale score at each time point after surgery and serum angiotensin Ⅱ and endothelin concentrations at 1 h after surgery were decreased, the incidence of adverse reactions was decreased( P<0.05), and no significant change was found in Steward score and emergence time in dexmedetomidine combined with oxycodone group( P>0.05). Conclusions:Compared with sufentanil, dexmedetomidine combined with oxycodone has a better analgesia efficacy with fewer adverse reactions in the patients undergoing percutaneous transforaminal endoscopic surgery.
RÉSUMÉ
ABSTRACT Objective: To compare the differences between transforaminal and interlaminar endoscopic approaches in terms of pain intensity and functionality 30 days after the surgical procedure. Methods: A retrospective cohort study, with patients treated by percutaneous interlaminar or transforaminal endoscopic discectomy at the Spine Service of the ISCMPA, in southern Brazil. Data were collected from the patients' electronic medical records by two independent physicians. The clinical outcomes of pain intensity and lumbar functionality were evaluated, respectively, using the visual analogue scale and the Oswestry Disability Index. Results: Thirty-six patients were included in the study, with a mean age of 50.8 ± 15.3 years, 19 (52.8%) of whom were males. As for the clinical outcomes for both transforaminal and interlaminar percutaneous endoscopic approaches, we observed a statistically significant reduction in pain intensity (mean difference of 3.5 points, p < 0.001) and a statistically significant improvement in functionality (mean difference of 33.2 points, p < 0.001) when we compared the pre- and 30-day postoperative periods, with no significant differences in terms of approaches. The type of technical approach also differed in relation to the patients' age, the location, type, and migration of the herniated disc, and the patient's time in the operating room. Conclusion: There was a similar effect on pain reduction and restoration of lumbar functions, 30 days after percutaneous endoscopic discectomy, in both technical approaches, with no significant differences between them. Level of Evidence III; Retrospective comparative study.
RESUMO Objetivo: Comparar as diferenças entre as abordagens endoscópicas transforaminal e interlaminar quanto à intensidade da dor e a funcionalidade 30 dias depois do procedimento cirúrgico. Métodos: Estudo de coorte retrospectivo, com pacientes tratados por discectomia endoscópica percutânea interlaminar ou transforaminal, em acompanhamento no Serviço de Coluna da ISCMPA, sul do Brasil. Os dados foram coletados do prontuário eletrônico dos pacientes por dois médicos independentes. Os desfechos clínicos de intensidade de dor e funcionalidade lombar foram avaliados, respectivamente, pela pontuação da escala visual analógica e do Oswestry Disability Index. Resultados: Trinta e seis pacientes foram incluídos no estudo; a média de idade foi 50,8 ± 15,3 anos, sendo 19 (52,8%), do sexo masculino. Quanto aos desfechos clínicos, observou-se diferença estatisticamente significativa para as abordagens endoscópicas percutânea transforaminal e interlaminar na redução da intensidade da dor (média da diferença 3,5 pontos, p < 0,001) e na melhora da funcionalidade (média da diferença 33,2 pontos, p < 0,001) quando comparados os momentos pré e em 30 dias pós-operatórios, sem diferença significativa com relação às abordagens. O tipo de abordagem técnica diferiu também com relação à idade dos pacientes, à localização, ao tipo e à migração da hérnia de disco e ao tempo do paciente em sala cirúrgica. Conclusões: Observou-se efeito semelhante na redução da dor e na restauração das funções lombares, 30 dias depois da discectomia endoscópica percutânea, em ambas as abordagens técnicas, sem diferenças significativas entre si. Nível de Evidência III;Retrospectivo comparativo.
RESUMEN Objetivos: Comparar las diferencias entre los abordajes endoscópicos transforaminal e interlaminar en cuanto a la intensidad y funcionalidad del dolor a los 30 días del procedimiento quirúrgico. Métodos: Estudio de cohorte retrospectivo, con pacientes tratados por discectomía endoscópica percutánea interlaminar o transforaminal, en acompañamiento en el Servicio de Columna - ISCMPA, sur de Brasil. Los datos fueron recopilados de las historias clínicas electrónicas de los pacientes por dos médicos independientes. Los resultados clínicos de la intensidad del dolor y la funcionalidad lumbar se evaluaron, respectivamente, utilizando la escala visual analógica y el Oswestry Disability Index. Resultados: Se incluyeron en el estudio 36 pacientes, con una edad promedio de 50,8 ± 15,3 años, 19 (52,8%) varones. En cuanto a los resultados clínicos, se observó una diferencia estadísticamente significativa para los enfoques endoscópicos percutáneos transforaminal e interlaminar en la reducción de la intensidad del dolor (diferencia media 3,5 puntos, p <0,001) y en la mejora de la funcionalidad (diferencia media 33,2 puntos, p <0,001) al comparar los períodos preoperatorios y postoperatorios a los 30 días, sin diferencia significativa en cuanto a los enfoques. El tipo de enfoque técnico también difirió con respecto a la edad de los pacientes, la ubicación, el tipo y la migración de la hernia de disco, y el tiempo del paciente en el quirófano. Conclusiones: Hubo un efecto similar en la reducción del dolor y la restauración de las funciones lumbares, 30 días después de la discectomía endoscópica percutánea, en ambos enfoques técnicos, sin diferencias significativas entre ellos. Nivel de Evidencia III; Estudio retrospectivo comparativo.
Sujet(s)
Humains , Adulte d'âge moyen , LombalgieRÉSUMÉ
Objective To prospectively assess the predictive power of centralization phenomenon in the curative effect of automated PLD.Methods The survey population was consisted of 109 patients with inclusion heraiation demonstrated by CT/MRI,74 men and 35 women with average age of 43.1 years(17～75 years). All were complained of low back pain,with varying degrees of lower extremity pain and altered sensation, lasting for more than 2 months;including one symptomatic disc in 99 patients and two symptomatic discs in 10 patients.Patients were undergone dynamic mechanical spinal test and reported whether the test would aggravate their pain.The assessment included forward flexion,extension,rotation of the trunk to the right and left, rotation to the left with fight extension,rotation to the fight with left extension,and whether straight leg raising in the supine position would aggravate back pain or leg pain.Symptom resposes were categorized into three groups:centralization group(CG),partial-centralization group(PCG)and noncentralization group(NCG). Centralization of pain is the progressive retreat of the most distal extent of the referred or radicular pain toward or to the lumbar midline.Noncentralization of pain is the peripheralization of pain in one or more directions, and no change in the distal-most pain location or intensity.All patients received a single therapy with PLD. Results A follow-up of 109 patients for 3 to 6 months,including 46 cases with 24 as exellent and 22 as good reaching 100% of excellent good rate in CG by MacNab standards;43 cases with 5 as exellent,29 as good,9 as fair and poor,with total effective rate of 79.1% in PCG.Twenty cases of NCG symptoms showed no improvement and therefore surgery was considered.Conclusions Centralization phenomenon occurrence during initial mechanical evaluation is a very accurate predictor for successful PLD outcome.Nonoccurrence of centralization would accurately predict poor PLD outcome and thus helpful as early predictor of the need for surgical treatment.