罗哌卡因复合倍他米松胸腰筋膜平面阻滞在腰椎手术后静脉镇痛中的效果

Effect of ropivacaine combined with betamethasone in thoracolumbar interfascial plane block on postoperative intravenous analgesia in lumbar surgery

目的比较罗哌卡因单独或复合倍他米松胸腰筋膜平面(TLIP)阻滞对腰椎手术术后镇痛效果的影响。方法选择2018年8月至2019年12月拟在全身麻醉下行后正中入路腰椎手术患者90例,男46例,女44例,年龄45~65岁,BMI 18~25 kg/m 2,ASAⅠ—Ⅲ级。随机分为三组:对照组(C组)、罗哌卡因阻滞组(R组)和罗哌卡因复合倍他米松阻滞组(RB组),每组30例。C组全身麻醉诱导后在L 3平面超声引导下双侧胸腰筋膜分别给予生理盐水20 ml。R组全身麻醉诱导后在L 3平面超声引导下双侧胸腰筋膜分别给予0.375%罗哌卡因20 ml,RB组全身麻醉诱导后在L 3平面超声引导下双侧胸腰筋膜分别给予0.375%罗哌卡因复合倍他米松5 mg的混合液20 ml,三组术后均行舒芬太尼PCIA。记录术中瑞芬太尼、丙泊酚用量,术后2、6、12、24、36、48 h静息和翻身时VAS疼痛评分,术后0~24、24~48 h PCIA有效按压次数、舒芬太尼用量、氟比洛芬酯追加剂量,术后呼吸抑制、恶心呕吐、颜面部水肿、寒战等不良反应发生情况。结果与C组比较,R组和RB组术中瑞芬太尼和丙泊酚用量明显减少(P<0.05),术后2、6、12 h静息时VAS疼痛评分和术后2、6、12、24 h翻身时VAS疼痛评分明显减少(P<0.05),术后0~24 h PCIA有效按压次数、舒芬太尼用量、氟比洛芬酯追加量明显减少(P<0.05);RB组术后24~48 h PCIA有效按压次数、舒芬太尼用量、氟比洛芬酯追加量明显减少(P<0.05);RB组术后恶心呕吐发生率明显减少(P<0.05)。与R组比较,RB组术后36、48 h翻身时VAS疼痛评分明显降低(P<0.05),术后24~48 h PCIA有效按压次数、舒芬太尼用量、氟比洛芬酯追加量明显减少(P<0.05)。三组术后均未出现呼吸抑制,术后颜面部水肿、寒战发生率差异无统计学意义。结论罗哌卡因复合倍他米松TLIP阻滞有效缓解了腰椎手术术后疼痛,延长了单药TLIP阻滞术后镇痛作用时间,减少了术后相关不良反应。

Objective To compare the effect of ropivacaine alone or combined with betamethasone in thoracolumbar interfascial plane(TLIP)block on postoperative analgesia in lumbar surgery.Methods Ninety patients undergoing posterior median approach lumbar surgery under general anesthesia from August 2018 to December 2019 were selected,46 males and 44 females,aged 45-65 years,BMI 18-25 kg/m 2,ASA physical statusⅠ-Ⅲ.The patients were divided into three groups randomly:control group(group C),ropivacaine blocked group(group R)and ropivacaine combined with betamethasone blocked group(group RB),each group enrolled 30 cases.Patients in group C,group R and group RB were injected 20 ml of normal saline,0.375%ropivacaine,and 0.375%ropivacaine combined with betamethasone 5 mg,respectively into the thoracolumbar interfascial plane under the ultrasound-guided at the level of the third lumbar vertebra in each side after the induction of general anesthesia.All patients received patient-controlled intravenous analgesia(PCIA).The intraoperative remifentanil and propofol dosage were recorded.The postoperative pain VAS score with resting and active states were recorded at 2,6,12,24,36,and 48 hours after surgery.The pressing times of PCIA pump,the consumption of sufentanil and flurbiprofen were recorded at 0-24 and 24-48 hours after surgery,and the side effects of postoperative respiratory depression,nausea and vomiting,facial edema,shivering were recorded as well.Results Compared with group C,the intraoperative consumption of remifentanil and propofol,the VAS score in resting state at the time of 2,6 and 12 hours after surgery and in active state at the time of 2,6,12,and 24 hours after surgery,the pressing times of PCIA pump,and the consumption of sufentanil and flurbiprofen at the time of 0-24 hours after surgery were decreased in group R and group RB(P<0.05).Compared with group C,the consumption of sufentanil and flurbiprofen at the time of 24-48 hours and the incidence of postoperative nausea and vomiting were decreased in group RB(P<0.05).Compared with group R,the VAS score at the time of 36 and 48 hours at active state,the pressing times of PCIA pump,the consumption of sufentanil and flurbiprofen at the time of 24-48 hours were decreased in group RB(P<0.05).There was no postoperative respiratory depression observed and no significant differences in facial edema and shivering between these three groups.Conclusion The application of ropivacaine combined with betamethasone TLIP block in analgesia for lumber surgery is effective,while extended one-time effective analgesia time of TLIP bolck,and reducing the related complications after operation.