Clinical Observation Of Preoperative Oral Gabapentin Combined With Gelatin Sponge Impregnated With Dexamethasone And Ropivacaine For Postoperative Analgesia After Short Segment Lumbar Posterior Surgery

Objective:To observe the clinical effects of oral gabapentin before operation and gelatin sponge impregnated with dexamethasone and ropivacaine during operation on postoperative analgesia of short segment lumbar posterior operation.Methods:A total of 300 cases underwent lumbar posterior 1²segment decompression and instrumentation were randomly subjected to6 different groups from May 2019 to January 2021.Each group was given oral gabapentin（1200mg）or nimesulide（0.1g tid）as preoperative analgesia respectively and gelatin sponge soaked with dexamethasone and or ropivacaine was placed between the transverse process and the facet process of the operative segment of the vertebrae before closing the incision.All groups received a patient-controlled analgesia（PCA）pump within 48 h after surgery.Analgesia treatment for each group was as follows:Nimesulide（oral 0.1g tid）as preoperative analgesia and gelatin sponge soaked with normal saline was placed between the transverse process and the facet process of the operative segment of the vertebrae before closing the incision in group 1（n=50）.Nimesulide（oral 0.1g tid）as preoperative analgesia and gelatin sponge soaked with dexamethasone and ropivacaine was placed between the transverse process and the facet process of the operative segment of the vertebrae before closing the incision in group 2（n=50）.Nimesulide（oral 0.1g tid）as preoperative analgesia and gelatin sponge soaked with dexamethasone was placed between the transverse process and the facet process of the operative segment of the vertebrae before closing the incision in group 3（n=50）.Nimesulide（oral 0.1g tid）as preoperative analgesia and gelatin sponge soaked with ropivacaine was placed between the transverse process and the facet process of the operative segment of the vertebrae before closing the incision in group 4（n=50）.Gabapentin（oral 1200mg）as preoperative analgesia and gelatin sponge soaked with normal saline was placed between the transverse process and the facet process of the operative segment of the vertebrae before closing the incision in group 5（n=50）.Gabapentin（oral 1200mg）as preoperative analgesia and gelatin sponge soaked with dexamethasone and ropivacaine was placed between the transverse process and the facet process of the operative segment of the vertebrae before closing the incision in group 6（n=50）.The age,gender,operative time,intraoperative blood loss,numbers of corrisponding vertebral body,and American Society of Anesthesiology（ASA）classification were recorded in each group and.Serum levels of Substance P（SP）,C-reactive Protein（CRP）and Erythrocyte Sedimentation Rate（ESR）were measured at 1h,24 h and 48 h after surgery.The postoperative visual analogue scale（VAS）of pain were evaluated every 6 hours within 48 h after surgery.Blood pressure was checked every one hour within 48 after surgery and blood pressure bariability（BPV）（expressed by standard deviation of Blood Pressure）was calculated.The adverse drug reactions was observed.Results: There were no significantly differences about the age,gender,SP,ESR,CRP,preoperative VAS,operation time,intraoperative blood loss,numbers of corresponding vertebral body and ASA grade among all groups rescpectively（P > 0.05）.The postoperative ESR value in 6^th group was significantly lower than it in the other five groups rescpectively（P < 0.05）.The SP and CRP in 2^nd,3^rd and 4^th groups were obviously lower than those in 1^st group,those in 2^nd and 3^rd groups were obviously lower than those in 4^th group,those in 6^th group was significantly lower than in 2^nd group,and those in 5^th group was significantly lower than that 1^st group（P < 0.05）.At 24 and 48 h after surgery,SP,CRP,ESR value of 2^nd,3^rd and 4^th groups were significantly lower than those in 1^st group,while 2^nd group was obviously lower than in3 rd and 4^th group,those in 6^th group was significantly lower than 2^nd group,5^th group was significantly lower than 1^st group（P < 0.05）.Within48 h after surgery,the pain VAS in 2^nd group was significantly lower than that in 3^rd,4^th and 1^st groups at all time points,3^rd and 4^th groups were significantly lower than that 1^st group,those in 6^th group was significantly lower than that in 2^nd group and 5^th group was significantly lower than in 1^st group（P < 0.05）.Standard deviations of systolic and diastolic blood pressure in group 1^st were significantly higher than in the other five groups（P < 0.05）.The incidence of abdominal pain,distension,nausea,vomiting and constipation in 5^th group was significantly lower than that in1 st group,and the incidence of abdominal pain,distension and constipation in group 6^th was significantly lower than that in group 2^nd（P< 0.05）.Conclusion: Oral administration of gabapentin 2 hours before surgery as preoperative analgesia,combined with gelatin sponge impregnated with dexamethasone and ropivacaine before inclosing the wound can safely and effectively inhibit the inflammatory response caused and relieve postoperative pain in patients with short segment posterior lumbar surgery.