超声引导下腰脊神经后内侧支优化阻滞复合全身麻醉在腰椎内固定术中的应用

Application of ultrasound guided optimized block of the posterior medial branch of the lumbar spinal nerve combined with general anesthesia in lumbar internal fixation

目的观察超声引导下行腰脊神经后内侧支优化阻滞复合全身麻醉在腰椎内固定术中的应用效果。方法选取2018年12月至2020年1月于南通大学附属如皋医院择期行腰椎内固定术的患者90例,将患者随机分为静吸复合全身麻醉组45例,超声引导下腰脊神经后内侧支优化阻滞复合静吸全身麻醉组45例。记录术中舒芬太尼总用量,脑电双频指数(BIS)值,术后0、4、8、12、24 h视觉模拟评分(VAS)及术后呕吐、皮肤瘙痒、嗜睡等并发症。结果2组术中BIS差异无统计学意义(P>0.05)。超声引导下腰脊神经后内侧支优化阻滞复合静吸全身麻醉组术中舒芬太尼用量少于静吸复合全身麻醉组(P<0.05)。超声引导下腰脊神经后内侧支优化阻滞复合静吸全身麻醉组术后0、4、8、12 h VAS评分明显小于静吸复合全身麻醉组(P均<0.05)。超声引导下腰脊神经后内侧支优化阻滞复合静吸全身麻醉组患者无术后呕吐、皮肤瘙痒、嗜睡发生。结论超声引导下腰脊神经后内侧支优化阻滞复合全身麻醉在腰椎内固定术中应用效果满意,且无明显不良反应。

Objective To observe the effect of ultrasound guided optimized block of the posterior medial branch of the lumbar spinal nerve combined with general anesthesia in lumbar internal fixation.Methods Ninety American Society for Anesthesiologists(ASA)ⅠorⅡpatients were randomly divided into two groups to receive either intravenous inhalation anesthesia(45 cases)or ultrasound guided optimal block of the posterior medial branch of the lumbar spinal nerve combined with general anesthesia(45 cases).The total dosage of sufentanil,bispectral index(BIS)value,visual analogue scales(VAS)scores at 0,4,8,12,and 24 hours after surgery,and complications such as vomiting,pruritus,and drowsiness were recorded.Results There was no significant difference in BIS scores between the two groups(P>0.05).The dosage of sufentanil in patients undergoing ultrasound guided optimal block of the posterior medial branch of the lumbar spinal nerve combined with general anesthesia was less than that of patients undergoing intravenous inhalation anesthesia(P<0.05),and the VAS scores in the combination group at 0,4,8,and 12 h were significantly lower than those of the intravenous inhalation anesthesia group(P<0.05).The incidence of vomiting,pruritus,and drowsiness in the combination group was lower than that of the intravenous inhalation anesthesia group(P<0.05).Conclusion Optimized block of the posterior medial branch of the lumbar spinal nerve under the guidance of ultrasound combined with general anesthesia in the lumbar internal fixation has satisfactory effects,with no obvious adverse effects observed.