超声引导下双侧竖脊肌平面阻滞用于腰椎后入路手术的临床效果

Clinical effect of ultrasound-guided bilateral erector spine plane block for posterior lumbar surgery

目的评价超声引导下双侧竖脊肌平面阻滞联合全身麻醉用于腰椎后入路手术的临床应用效果。方法选择江苏省淮安市淮阴医院2019年1月至2020年1月择期全身麻醉下行腰椎后入路减压内固定、植骨融合术患者54例,随机分为竖脊肌平面阻滞组(观察组)和对照组,每组27例。2组均采用静脉-吸入复合全身麻醉。在麻醉诱导前,观察组患者行俯卧位超声引导下双侧L3横突水平竖脊肌平面阻滞,对照组不进行其他操作。观察指标:术中舒芬太尼用量,术后1 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)5个时间点视觉模拟评分(VAS)以及与麻醉、镇痛、神经阻滞的相关并发症。结果观察组术中舒芬太尼用量(25.09±3.00)μg明显少于对照组(28.51±5.30)μg,差异有统计学意义(P<0.05),观察组患者T2、T3、T4时的VAS评分明显低于对照组(P<0.05),2组T1、T5时点VAS评分、补救镇痛例数以及术后相关并发症差异无统计学意义(P>0.05)。结论超声引导双侧竖脊肌平面阻滞可以减少腰椎后入路手术术中舒芬太尼用量,降低术后VAS评分,优化麻醉质量并提供良好的术后镇痛效果。

Objective To evaluate the clinical effect of ultrasound-guided bilateral erector spine plane block combined with general anesthesia for posterior lumbar surgery.Methods Fifty-four patients who underwent posterior lumbar surgery under general anesthesia were randomly divided into the erector spine plane block(or the experimental group)and the control group,each consisting of 27 patients.The patients in the 2 groups all had inhalation and general anesthesia.Before induction of anesthesia,the patients in the experimental group had ultrasound-guided bilateral erector spine plane block with prone position at L3,while the patients in the control group remained intact with other manipulations.The main observation indexes were:the amount of sufentanil consumption(μg)during surgery,VAS scores at 1 h(T1),6 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after surgery,as well as complications related to anesthesia,analgesia and nerve block.Results The consumption of sufentanil during surgery in the experimental group(25.09±3.00)μg was significantly less than that in the control group(28.51±5.30)μg(P<0.05).The VAS scores at T2,T3 and T4 in the experimental group were significantly lower than those in the control group(P<0.05).There was no statistical significance in VAS scores at T1 and T5 and in the cases of postoperative analgesia and related complications,when comparisons were made between the 2 groups(P>0.05).Conclusion Ultrasound-guided bilateral erector spine block could reduce sufentanil consumption during surgery in patients undergoing posterior lumber surgery,decrease VAS scores after surgery,improve anesthesia quality and achieve good postoperative analgesic result.