[ERAS Guidelines] Lumbar Fusion 腰椎融合手術(術前、術中、術後)臨床照顧建議指引

腰椎融合手術 (Lumbar Fusion) 隨著人口的老化在各國都不斷在成長中。考量到腰椎融合手術曾在179種術式中,被評比為疼痛分數第二高 (1-2節)、及第三高 (>3節) 的術式,再加上接受手術的病人族群年紀較大、身體較衰弱 (Frail),ERAS Society 組成了專家小組整理過去的文獻資料,對21項處置給予evidence level及recommendation grade的分級,制定了ERAS官方建議照顧指引,於2021年01月22月發表於 The Spine Journal。




其中 high evidence level 及 strong recommendation 的包含:

  • Preoperative fasting and carbohydrate treatment
    • - Clear fluid should be permitted up to 2 hours and solid foods up to 6 hours before the induction of general anesthesia.
  • Antimicrobial prophylaxis and skin preparation
    • - Administration of a broad-spectrum antibiotic covering S. aureus (with possibility of repeating doses during longer surgeries).
    • - Skin preparation using use of either alcohol-based iodine or chlorohexidine solution.
  • Preventing intraoperative hypothermia
    • - Normothermia should be maintained peri- and postoperatively through pre-warming and the active warming of patients intraoperatively.
  • Local anesthetic techniques
    • -Use of intrathecal morphine, epidural analgesia, or wound infiltration with long-acting local anesthetics should be used to improve postoperative pain management.
  • Postoperative nausea and vomiting
    • - Risk assessment for PONV, routinely use of multimodal PONV prophylaxis based on assessment, and PONV rescue with different class of anti-emetic are recommended.




論文連結:

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS) Society recommendations

Bertrand Debono et. al.

Published 11 January, 2021