Application of pain management in enhancing patient recovery after percutaneous kyphoplasty surgery_West China Medical Journal

Authors：

LIAO Yehui , TANG Qiang , TANG Chao , LUO Ning , MA Fei ,  ZHONG Dejun , WANG Qing

Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

ZHONG Dejun, Email: zdj_1974@163.com

Keywords：

Enhanced recovery after surgery; Percutaneous kyphoplasty; Pain management; Patient satisfaction

DOI：

10.7507/1002-0179.201808085

Video：

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Objective To manage the preoperative, intraoperative and postoperative pain of percutaneous kyphoplasty (PKP) under the concept of enhanced recovery after surgery (ERAS) and explore the role of pain management under the ERAS concept in enhancing postoperative rehabilitation of PKP. Methods From January to December 2016, 136 patients with osteoporotic compression fractures treated with PKP of local anesthesia were selected, among which 71 patients in the ERAS group were treated between July and December 2016, who were treated with celecoxib capsule for analgesia before the operation and such local anesthetics as lidocaine and ropivacaine combined with intravenous injection of dexmedetomidine hydrochloride for multi-mode analgesia during the operation; after the operation, celecoxib capsules and tizanidine hydrochloride tablets were orally administered by the routine for analgesia; if the pain was increased, 40 mg parecoxib would be added for analgesia by intramuscular injection. While 65 patients in the conventional group were treated between January and June 2016, who were given intraoperative local anesthesia with lidocaine; if the patients suffered from severe pain after the operation, they would be given 40 mg parecoxib by intramuscular injection. The Visual Analogue Scale (VAS), mean arterial pressure (MAP), the complications after surgery, postoperative infections, bed rest time, length of hospital stay and patient satisfaction were compared between the two groups. Results There was no statistical difference in age, gender or fracture vertebral number between the two groups (P>0.05). The preoperative, intraoperative and postoperative VAS scores (4.0±1.5, 4.8±1.8, 1.6±1.1), MAP change [(22.0±4.7) mm Hg (1 mm Hg=0.133 kPa)], bed rest time [(1.5±0.7) days], and length of hospital stay [(3.8±0.8) days] in the ERAS group were significantly less than those in the conventional group [4.7±1.7, 5.7±1.5, 2.4±1.1, (31.3±6.1) mm Hg, (2.1±0.8) days, and (5.0±1.6) days, respectively] (P<0.05). The incidence of intraoperative complication of bone cement leakage (4.2%, 3/71) in the ERAS group was lower than that in the conventional group (13.8%, 9/65) (P<0.05); there was no statistical difference in postoperative pulmonary infection between the two groups (P>0.05). Patients’ satisfaction was significantly improved from 86.2% (the conventional group) to 95.8% (the ERAS group) (P<0.05). There was no incision infection, urinary tract infection or venous thrombosis in the two groups. Conclusion With the concept of ERAS, taking a management of pain can effectively alleviate the dis-comfortable pain feeling, improve the patients’ satisfaction, and enhance the recovery for the patients after PKP surgery.

Citation： LIAO Yehui, TANG Qiang, TANG Chao, LUO Ning, MA Fei, ZHONG Dejun, WANG Qing. Application of pain management in enhancing patient recovery after percutaneous kyphoplasty surgery. West China Medical Journal, 2018, 33(9): 1173-1176. doi: 10.7507/1002-0179.201808085 Copy

1.	Nas ?F, ?necikli MF, Hac?kurt K, et al. Effectiveness of percutaneous vertebroplasty in patients with multiple myeloma having vertebral pain. Diagn Interv Radiol, 2016, 22(3): 263-268.
2.	趙志剛, 勘武生, 李鵬. 經皮椎體成形術治療新鮮骨質疏松性椎體壓縮性骨折. 中華創傷骨科雜志, 2014, 16(3): 218-221.
3.	Harland NJ, Dawkin MJ, Martin D. Relative utility of a visual analogue scale vs. a six-point Likert scale in the measurement of global subject outcome in patients with low back pain receiving physiotherapy. Physiotherapy, 2015, 101(1): 50-54.
4.	李曄, 寧寧, 屈俊宏, 等. 階段性顱骨牽引在頸椎關節突交鎖患者快速康復中的臨床效果觀察. 華西醫學, 2017, 32(3): 428-430.
5.	Heikkil? K, Peltonen LM, Salanter? S. Postoperative pain documentation in a hospital setting: a topical review. Scand J Pain, 2016, 11: 77-89.
6.	劉銘, 劉欣偉, 張敬東, 等. 關節置換圍術期快速康復研究進展. 創傷與急危重病醫學, 2016, 4(4): 214-217.
7.	Marques EM, Jones HE, Elvers KT, et al. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. BMC Musculoskelet Disord, 2014, 15: 220.
8.	李強, 李群, 全竹富, 等. 加速康復外科理念在胰體尾切除手術中的應用. 中國普通外科雜志, 2012, 21(9): 1144-1146.
9.	周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復外科—圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
10.	李小軍. 舒經活絡膏外擦治療胸腰椎壓縮性骨折 PKP 術后疼痛的療效觀察. 中醫外治雜志, 2016, 25(5): 19-20.
11.	Feldheiser A, Aziz O, Baldini G, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
12.	彭慧明, 唐杞衡, 錢文偉, 等. 膝關節周圍注射鎮痛在全膝關節置換術后多模式鎮痛方案中的作用. 中華骨科雜志, 2016, 36(7): 406-412.
13.	沈彬, 翁習生, 廖刃, 等. 中國髖、膝關節置換術加速康復—圍術期疼痛與睡眠管理專家共識. 中華骨與關節外科雜志, 2016, 9(2): 91-97.
14.	鄧永鴻, 張慧, 曾子, 等. 加速康復外科護理對膝關節置換術患者膝關節功能影響的系統評價. 護理學報, 2017, 24(12): 27-32.
15.	吳偉, 黃偉杰, 陳世益. 加速康復外科在老年股骨粗隆間骨折治療中的應用. 實用骨科雜志, 2011, 17(2): 117-119.

1. Nas ?F, ?necikli MF, Hac?kurt K, et al. Effectiveness of percutaneous vertebroplasty in patients with multiple myeloma having vertebral pain. Diagn Interv Radiol, 2016, 22(3): 263-268.
2. 趙志剛, 勘武生, 李鵬. 經皮椎體成形術治療新鮮骨質疏松性椎體壓縮性骨折. 中華創傷骨科雜志, 2014, 16(3): 218-221.
3. Harland NJ, Dawkin MJ, Martin D. Relative utility of a visual analogue scale vs. a six-point Likert scale in the measurement of global subject outcome in patients with low back pain receiving physiotherapy. Physiotherapy, 2015, 101(1): 50-54.
4. 李曄, 寧寧, 屈俊宏, 等. 階段性顱骨牽引在頸椎關節突交鎖患者快速康復中的臨床效果觀察. 華西醫學, 2017, 32(3): 428-430.
5. Heikkil? K, Peltonen LM, Salanter? S. Postoperative pain documentation in a hospital setting: a topical review. Scand J Pain, 2016, 11: 77-89.
6. 劉銘, 劉欣偉, 張敬東, 等. 關節置換圍術期快速康復研究進展. 創傷與急危重病醫學, 2016, 4(4): 214-217.
7. Marques EM, Jones HE, Elvers KT, et al. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. BMC Musculoskelet Disord, 2014, 15: 220.
8. 李強, 李群, 全竹富, 等. 加速康復外科理念在胰體尾切除手術中的應用. 中國普通外科雜志, 2012, 21(9): 1144-1146.
9. 周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復外科—圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
10. 李小軍. 舒經活絡膏外擦治療胸腰椎壓縮性骨折 PKP 術后疼痛的療效觀察. 中醫外治雜志, 2016, 25(5): 19-20.
11. Feldheiser A, Aziz O, Baldini G, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
12. 彭慧明, 唐杞衡, 錢文偉, 等. 膝關節周圍注射鎮痛在全膝關節置換術后多模式鎮痛方案中的作用. 中華骨科雜志, 2016, 36(7): 406-412.
13. 沈彬, 翁習生, 廖刃, 等. 中國髖、膝關節置換術加速康復—圍術期疼痛與睡眠管理專家共識. 中華骨與關節外科雜志, 2016, 9(2): 91-97.
14. 鄧永鴻, 張慧, 曾子, 等. 加速康復外科護理對膝關節置換術患者膝關節功能影響的系統評價. 護理學報, 2017, 24(12): 27-32.
15. 吳偉, 黃偉杰, 陳世益. 加速康復外科在老年股骨粗隆間骨折治療中的應用. 實用骨科雜志, 2011, 17(2): 117-119.

West China Medical Journal

Application of pain management in enhancing patient recovery after percutaneous kyphoplasty surgery

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