左旋布比卡因联合氨甲环酸对腰椎后路融合术后镇痛的临床研究OA

Objective To observe the clinical efficacy and safety of local infiltration of levobupivacaine injection combined with tranexamic acid injection in patients undergoing posterior lumbar interbody fusion.Methods Patients undergoing posterior lumbar interbody fusion surgery in our hospital were divided into treatment group and control group based on the local infiltration medication regimen postoperatively.The control group received 20 mL of normal saline for local infiltration,and the treatment group received 20 mL of a mixed solution containing levobupivacaine injection(concentration 0.25％,37.5 mg diluted to 15 mL)and tranexamic acid injection(concentration 10％,0.2 g diluted to 5 mL).The two groups were compared in terms of visual analogue scale(VAS)scores at rest and during activity at 2,6,12,24 and 48 hours postoperatively,postoperative rescue analgesia rate,serum inflammatory markers,stress indicators at 24 hours postoperatively,postoperative recovery indicators,and safety evaluation was conducted.Results A total of 92 patients were finally enrolled,with 48 in control group and 44 in treatment group.After treatment,the resting VAS scores at 48 hours postoperatively in control group and treatment group were(1.75±0.44)and(1.55±0.50)points,respectively;the activity VAS scores were(2.54±0.50)and(2.32±0.47)points,respectively;the interleukin-6(IL-6)levels at 24 hours postoperatively were(57.02±5.15)and(54.23±4.52)pg·mL-1,respectively;the tumor necrosis factor-α(TNF-α)levels were(34.12±5.40)and(30.88±5.13)pg·mL-1,respectively;the S100 calcium-binding protein B(S100β)levels were(110.78±9.66)and(104.13±10.54)pg·mL-1,respectively;the serum cortisol(Cor)levels were(95.87±14.69)and(89.43±13.73)ng·mL-1,respectively;the norepinephrine(NE)levels were(369.43±51.81)and(342.86±48.13)ng·mL-1,respectively;the advanced oxidation protein products(AOPP)levels were(66.19±12.36)and(58.97±11.74)μmol·L-1,respectively;the rescue analgesia rates at 0-11 h postoperatively were 33.33％(16 cases/48 cases)and 13.64％(6 cases/44 cases),respectively;and at 12-24 h were 22.92％(11 cases/48 cases)and 6.82％(3 cases/44 cases),respectively;the first ambulation time were(2.79±0.62)and(2.48±0.55)days,the first flatus time were(30.79±5.35)and(28.02±5.20)hours,the hospital stay were(7.38±1.44)and(6.66±1.29)days,respectively;and the quality of recovery-15(QoR-15)score at postoperative day 3 were(116.69±7.42)and(121.66±8.72)points,respectively;statistically significant differences were observed in all the above indicators between the two groups(all P＜0.05).The adverse drug reactions in treatment group included nausea and vomiting,fever and urinary retention,while those in control group included fever,nausea and vomiting,urinary retention and pruritus.The overall incidence of adverse drug reactions in treatment group and control group were 9.09％(4 cases/44 cases)and 14.58％(7 cases/48 cases),respectively;complications included poor wound healing,with incidence rates of 2.27％(1 case/44 cases)and 2.08％(1 case/48 cases),respectively,with no statistically significant differences between the groups(P＞0.05,P＞0.01).Conclusion In posterior lumbar interbody fusion,local infiltration of levobupivacaine injection combined with tranexamic acid injection around the incision provides more effective and sustained postoperative analgesia,significantly reduces systemic inflammation and stress response,promotes early postoperative rehabilitation,shortens hospital stay,and does not increase the risk of complications.