超声引导下不同入路胸腰筋膜平面阻滞用于腰椎手术术后镇痛

Influence of Different Approaches of Ultrasound-guided TLIP Block on Postoperative Analgesia in Lumbar Spine Surgery

目的探讨超声引导下不同入路胸腰筋膜平面(TLIP)阻滞对腰椎手术术后镇痛的影响。方法选择拟在全麻下行腰椎手术患者52例随机分为两组,每组各26例,A组在超声引导下内侧入路分别给予双侧最长肌与髂肋肌之间的胸腰筋膜0.4%罗哌卡因各20 mL,B组在超声引导下外侧入路分别给予双侧多裂肌与最长肌之间的胸腰筋膜0.4%罗哌卡因各20 mL。术后患者均给予舒芬太尼静脉自控镇痛(PCIA)。记录两组围术期瑞芬太尼及舒芬太尼用量;术后2、4、8、12、24 h的静息模拟疼痛(VAS)评分;术后恶心呕吐、头晕、呼吸抑制和瘙痒不良反应发生情况。结果A组患者术中瑞芬太尼及术后舒芬太尼用量,术后2、4、8、12、24 h静息VAS评分明显低于B组(P<0.05)。A组患者术后恶心呕吐、头晕发生率明显低于B组(P<0.05),两组患者均未出现呼吸抑制和瘙痒。结论超声引导下内侧入路最长肌与髂肋肌间TLIP阻滞较外侧入路多裂肌与最长肌间TLIP阻滞有更好的术后镇痛效果及更低的术后并发症发生率。

Objective To investigate the influence of different approaches of ultrasound-guided thoracolumbar interfascial plane(TLIP)block on postoperative analgesia in lumbar spine surgery.Methods Fifty-two patients undergoing lumbar surgeries under general anesthesia were randomly divided into two groups.20ml of 0.4%ropivacaine was injected into the thoracolumbar interfascial plane between longissimus and iliocostalis muscles at the level of the third lumbar vertebra in each side in Group A and 20ml of 0.4%ropivacaine was injected into the thoracolumbar interfascial plane between multifidus and longissimus muscles at the same level in each side in Group B.All patients received patient-controlled intravenous analgesia(PCIA).The dosage of remifentanil intraoperative and sufentanil postoperation,the visual analogue scores(VAS)at 2 h,4 h,8 h 12 h,24 h and 48 h after operation,nausea and vomiting,pruritus,dizziness,respiratory depression were recorded.Results The dosage intraoperative remifentanil,postoperative sufentanil,and the VAS at 2 h,4 h,8 h,12 h,24 h and 48 h after operation in group A were significantly lower than that in group B(P<0.05).The incidence of nausea and vomiting,pruritus were significantly lower in group A than that in group B(P<0.05).There was no statistically significant difference in dizziness and respiratory depression between the two groups.Conclusion The Ultrasound-guided TLIP block between the longissimus and iliocostalis muscle under the medial approach has better postoperative analgesia and lower postoperative complications rate than the TLIP block between the lateral approach multifidus and the longissimus muscle.