内侧与外侧入路TLIP阻滞联合PCIA在腰椎微创TLIF术中的应用对比

Application of TLIP block through medial and lateral approach combined with PCIA in minimally invasive TLIF

目的探讨内侧与外侧入路胸腰筋膜间平面阻滞(thoraco lumbar interfascial planeblock,TLIP)联合自控静脉镇痛(patient controlled intravenous analgesia,PCIA)在微创经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)中的镇痛效果。方法选取2019年1月~2020年10月行微创TLIF手术的患者69例,随机单盲法分为内侧入路组35例、外侧入路组34例。内侧入路组实施内侧入路TLIP+全麻+术后PCIA,外侧入路组实施外侧入路TLIP+全麻+术后PCIA。记录两组入路的一次性穿刺成功率、阻滞效果和穿刺时间,记录术前、术中、术毕的心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP),术中舒芬太尼与丙泊酚的麻醉维持用量,术后48 h内PCIA按压次数、PCIA总用量、帕瑞昔布与地佐辛的补救镇痛用量,术后VAS疼痛评分以及围手术期不良反应。结果内侧入路组的一次穿刺成功率为82.86%,外侧入路组为100%,差异有统计学意义(P<0.05);内侧入路组的穿刺时间明显长于外侧入路组(P<0.05)。两组在阻滞20 min后测定的感觉减退范围面积差异无统计学意义(P>0.05)。内侧入路组和外侧入路组在术前、术中30、60、120min以及术毕的HR、SBP和DBP差异均无统计学意义(P>0.05);术中舒芬太尼与丙泊酚的麻醉维持用量差异均无统计学意义(P>0.05);术后48 h内平均PCIA按压次数、PCIA总用量、帕瑞昔布与地佐辛补救镇痛用量差异均无统计学意义(P>0.05);术后6、12、24、48 h的VAS疼痛评分差异均无统计学意义(P>0.05);两组围手术期不良反应率差异无统计学意义(P>0.05)。结论内侧与外侧入路TLIP阻滞效果大体相当,但外侧入路TLIP操作更容易。

Objective To investigate the anesthetic effects of thoraco-lumbar interfascial plane block(TLIP)through medial and lateral approach combined with patient controlled intravenous analgesia(PCIA)in minimally invasive transforaminal lumbar interbody fusion(TLIF).Methods A total of 69 patients who underwent minimally invasive TLIF from January 2019 to October 2020 were enrolled.Using single-blind randomized method,the patients were divided into medial approach group(35 cases)and lateral approach group(34 cases).The medial approach group was given TLIP through medial approach combined with general anesthesia and postoperative PCIA,and the lateral approach group was given TLIP through lateral approach combined with general anesthesia and postoperative PCIA.The following items were recorded:the success rate of one puncture,blocking effect and puncture time,preoperative,intraoperative and postoperative heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP),the dosages of sufentanil and propofol used for anesthesia maintenance during operation,the number of PCIA compressions and the total consumption of PCIA within 48 h after operation,the dosages of parecoxib and dezocine used for remedial analgesia within 48 h after operation,postoperative VAS pain scores,and perioperative adverse reactions.Results The success rate of one puncture in the medial approach group was 82.86%,and that in the lateral approach group was 100%.The difference was statistically significant(P<0.05).The puncture time in the medial approach group was significantly longer than that in the lateral approach group(P<0.05).There was no significant difference in sensory block area between the two groups after block for 20 min(P>0.05).There were no significant differences in HR,SBP and DBP between the two groups before operation,30 min,60 min,and 120 min during operation and after operation(P>0.05).There were no significant differences in the intraoperative dosages of sufentanil and propofol used for anesthesia maintenance between the two groups(P>0.05).There were no significant differences in the average number of PCIA compressions and total consumption of PCIA within 48 h after operation between the two groups(P>0.05).There were no significant differences in the dosages of parecoxib and dezocine used for remedial analgesia within 48 h after operation between the two groups(P>0.05).There were no significant differences in the VAS pain scores at 6 h,12 h,24 h,and 48 h after operation between the two groups(P>0.05).There was no significant difference in the incidence rate of adverse reactions between the medial approach group and lateral approach group(P>0.05).Conclusion The block effects of TLIP through medial approach and lateral approach are almost the same,but the TLIP through lateral approach is easier to perform in the clinical application.