胸腰筋膜间平面阻滞对后路腰椎融合术后镇痛效果的影响

Efficacy of thoracolumbar interfascial plane block for postoperative analgesia in patients undergoing posterior lumbar fusion surgery

目的探讨超声引导下胸腰筋膜间平面(thoracolumbar interfascial plane, TLIP)阻滞对后路腰椎融合手术病人术后镇痛效果的影响。方法前瞻性选择2017年4月至2018年5月在我院择期行后路腰椎融合手术病人50例。采用随机数字表法分为两组,每组25例,TLIP阻滞联合静脉自控镇痛(patient controlled intravenous analgesia,PCIA)组(TLIP组)和单纯PCIA组(对照组)。TLIP组,男12例,女13例,年龄为(49.4±7.7)岁;对照组,男10例,女15例,年龄为(49.5±7.1)岁。TLIP组在全麻诱导后行超声引导下双侧TLIP阻滞,每侧注入0.375%罗哌卡因20 ml。两组术后均使用舒芬太尼行PCIA,维持术后24 h内静息疼痛视觉模拟量表(visual analogue scale, VAS)评分≤3分。记录两组病人围手术期阿片类药物用量及补救镇痛例数,术后2、4、6、12、24 h的静息VAS评分和Ramsay镇静评分,术后24 h内恶心呕吐、头晕、瘙痒和呼吸抑制的发生情况以及TLIP组阻滞相关并发症的发生情况。结果与对照组比较,TLIP组术中瑞芬太尼用量及术后24 h内PCIA舒芬太尼用量明显减少(P<0.05),术后恶心呕吐发生率明显降低(P<0.05),两组均未行补救镇痛。两组间各时间点静息VAS评分和Ramsay镇静评分,以及术后头晕、瘙痒和呼吸抑制等发生率的差异均无统计学意义(P均>0.05),TLIP组未发生阻滞相关并发症。结论超声引导下TLIP阻滞可减少后路腰椎融合术病人围术期阿片类药物用量,降低术后恶心呕吐的发生率。

Objective To investigate the efficacy of ultrasound-guided thoracolumbar interfascialplane(TLIP) block for postoperative analgesia in patients undergoing posterior lumbar fusion surgery.Methods Fifty patients who were scheduled for posterior lumbar fusion surgery in our hospital from April2017 to May 2018 were randomly divided into 2 groups(25 cases each) using a random number table: TLIPblock combined with patient controlled intravenous analgesia(PCIA)(TLIP group) and PCIA control group. Inthe TLIP group, there were 12 males and 13 females, aged(49.4±7.7) years, and there were 10 males and 15 females, aged(49.5±7.1) years in the control group. After induction of anesthesia, ultrasound-guided bilateralTLIP block was performed, and 20 ml of 0.375% ropivacaine was injected in each side in TLIP group. All thepatients received PCIA with sufentanil after operation, and visual analogue scale(VAS) scores at rest weremaintained equal or lesser than 3. The consumption of perioperative opioids and the number of requirements forrescue analgesic within 24 h after surgery were recorded. VAS scores at rest and Ramsay sedation scores wereregistered at 2, 4, 6, 12 and 24 h after surgery. The occurrence of nausea and vomiting, pruritus, dizziness,respiratory depression and TLIP block-related complications were recorded during the analgesic period.Results As compared with control group, the consumption of remifentanil during surgery, the amount ofsufentanil consumed and the incidence of nausea and vomiting within 24 h after operation were significantlydecreased in TLIP group(P<0.05). There was no patient required rescue analgesic in two groups. Nosignificant difference was found in VAS scores and Ramsay sedation scores at different time points, and theoccurrence of pruritus, dizziness, respiratory depression between two groups(P>0.05). TLIP block-related complications were not found in TLIP group. Conclusion Ultrasound-guided TLIP block not only reduces theperioperative opioids consumption, but also decline the incidence of nausea and vomiting in patients undergoingposterior lumbar fusion surgery.