超声引导下双侧竖脊肌平面阻滞对后路腰椎融合术后镇痛效果的影响

Analgesic efficacy of ultrasound-guided bilateral erector spinae plane block in patients undergoing posterior lumbar interbody fusion

目的探讨超声引导下双侧竖脊肌平面阻滞(erector spinae plane block, ESPB)用于后路腰椎融合术后镇痛的效果。方法选择2018年7-11月择期行后路腰椎融合术的患者40例,男27例,女13例,年龄18~75岁,ASAⅠ或Ⅱ级,按照随机数字表法将患者分为ESPB组(研究组)和对照组,每组20例。研究组在全身麻醉诱导前行双侧L4水平的ESPB,双侧分别推注0.4%罗哌卡因20 ml,注药后20 min使用针刺痛觉评估法监测感觉阻滞平面。两组患者均接受全身麻醉,术后镇痛方案为舒芬太尼PCIA。记录术后1、6、12、24、36和48 h的舒芬太尼累积用量、静息VAS疼痛评分、补救镇痛情况和术后住院时间等;相关不良反应(恶心呕吐、呼吸抑制)以及阻滞相关并发症(穿刺部位感染、血肿、局麻药中毒)。结果术后1、6、12、24、36和48 h,研究组静息VAS疼痛评分和舒芬太尼累积用量均明显低于对照组(P<0.05)。两组补救镇痛、术后不良反应发生率及术后住院时间差异无统计学意义。研究组未出现穿刺部位感染、血肿和局麻药中毒等并发症。结论超声引导下双侧ESPB可有效提高后路腰椎融合术患者术后镇痛的效果。

Objective To evaluate the analgesic efficacy of ultrasound-guided bilateral erector spinae plane block(ESPB) in patients undergoing posterior lumbar interbody fusion. Methods Forty patients, 27 males and 13 females, aged 18-75 years, falling into ASA physical status Ⅰ-Ⅱ, scheduled for elective posterior lumbar interbody fusion from July to November 2018 were enrolled and randomly divided into two groups: ESPB group(n = 20) and control group(n = 20). For ESPB group, patients received ultrasound-guided bilateral ESPB with 0.4% ropivacaine 20 ml on each side at the level of the L4 transverse process before the general anesthesia. Pinprick sensory tests were performed with a gauge blunt needle at 20 min after block. All the patients received general anesthesia and patient-controlled intravenous analgesia with sufentanil. Cumulative sufentanil consumption, visual analogue scores at rest, the associated side effects including the occurrence of nausea/vomiting and respiratory depression, requirements for rescue analgesia and postoperative length of stay were recorded at 1, 6, 12, 24, 36, 48 h after the surgery. The level of sensory blockade and ESPB related complications including local infection, hematoma, and local anesthetic intoxication were recorded in the ESPB group. Results The cumulative sufentanil consumption and visual analogue scores at 1, 6, 12, 24, 36, 48 h in the ESPB group was significantly less compared with the control group(P < 0.05). There were no significant differences in the requirements for rescue analgesia, the occurrence of side effects and postoperative length of stay between the two groups. No ESPB related complications such as local infection, hematoma, or local anesthetic intoxication was found. Conclusion Ultrasound-guided bilateral erector spinae plane block can significantly improve the analgesic efficacy for the patients undergoing posterior lumbar interbody fusion.