超声引导下腰段竖脊肌平面阻滞范围的确定及在腰椎手术中的应用

Determination of the block range of ultrasound-guided lumbar erector spinal plane and its application in lumbar spine surgery

目的确定腰段竖脊肌平面阻滞(ESPB)的阻滞范围,探讨其用于腰椎手术的有效性。方法选取2019年11月至2020年8月于温州医科大学附属第二医院择期行后路腰椎融合术的患者40例,随机数字表法分为两组(n=20):试验组和对照组。两组患者分别在麻醉诱导前行超声引导下L2横突水平双侧ESPB,试验组患者每侧给予0.375%罗哌卡因注射液20 ml,对照组患者每侧给予生理盐水20 ml。分别于阻滞后10、20及30 min测定温度觉减退范围,记录并比较两组患者围手术期镇痛药用量、疼痛视觉模拟(VAS)评分、不良反应发生率等指标的差异。结果试验组患者行ESPB后10、20及30 min温度觉减退范围及阻滞面积分别为T9~S1(222±16)cm^(2)、T8~S2(352±22)cm^(2)及T8~S3(481±24)cm^(2)。试验组患者术中瑞芬太尼用量为(0.76±0.02)mg,低于对照组的(0.97±0.06)mg(P<0.05);试验组患者术后0~12 h及12~24 h羟考酮用量分别为(4.9±0.4)、(8.4±1.2)mg,低于对照组的(14.5±2.4)、(19.3±2.4)mg(均P<0.05)。试验组患者24 h内的静息和运动VAS评分均低于对照组(均P<0.05)。试验组患者术后床上被动锻炼时间为(3.3±0.3)h,早于对照组的(4.6±0.3)h(P<0.05)。结论腰段ESPB后T12~S1节段阻滞效果确切,可有效减少腰椎融合术中及术后镇痛药用量,降低术后VAS评分,有助于患者术后快速康复。

Objective To determinate the block range of lumbar erector spinal plane(ESPB),and investigate the efficacy of ESPB in lumbar spine surgery.Methods Forty patients who underwent posterior lumbar fusion in the Second Affiliated Hospital of Wenzhou Medical University from November 2019 to August 2020 were randomly divided into two groups(with n=20 in each group)using the random number table:the experimental group(group E)and control group(group C).All the patients received ultrasound-guided bilateral ESPB with 20 ml of 0.375%ropivacaine(group E)or equal volume of normal saline(group C)on each side before induction of general anesthesia.The range of weakened temperature sense in each patient was measured at 10 min,20 min and 30 min after ESPB,respectively.Dosage of analgesic drug,visual analog scale(VAS),and incidence of adverse events were recorded and compared between the two groups.Results In group E,the dermatomal distribution and area of weakened temperature sense at 10 min,20 min,30 min after ESPB were T9-S1(222±16)cm2,T8-S2(352±22)cm2,T8-S3(481±24)cm2,respectively.The intraoperative dosage of remifentanil in group E was(0.76±0.02)mg,which was significantly lower than that of group C(0.97±0.06)mg(P<0.05).Oxycodone consumption in group E at 0-12 h and 12-24 h after surgery was(4.9±0.4)mg and(8.4±1.2)mg,respectively,which were lower than those in group C[(14.5±2.4)mg and(19.3±2.4)mg,respectively](both P<0.05).The VAS during rest and movement within 24 h after operation in group E were significantly lower than those in group C(both P<0.05).The passive exercise in bed in group E started at(3.3±0.3)h postoperatively,which was earlier than that in group C(4.6±0.3)h(P<0.05).Conclusion The blocking effects of T12-S1 segment after ultrasound-guided lumbar ESPB is definite,which can effectively decrease the amounts of analgesics during and after the lumbar fusion surgery,reduce postoperative rest and exercise VAS score,and contribute to a rapid recovery of the patients.