竖脊肌平面阻滞在后入路腰椎手术患者围术期的应用效果及对早期恢复的影响

Perioperative effect of erector spinal muscle plane block in posterior approach lumbar surgery and its effect on early postoperative recovery.

目的评价超声引导下竖脊肌平面阻滞(ESPB)在后入路腰椎手术围术期应用效果及对术后早期恢复质量的影响。方法选择在医院接受后入路腰椎手术的患者80例,采用随机数字表法分为ESPB组和对照组(C组),每组40例。在常规麻醉基础上,ESPB组患者在超声下确认针头末端位于竖脊肌深面后在手术两侧各注入0.375%的罗哌卡因20 mL;C组则注入等量的生理盐水。术后两组给予患者自控静脉镇痛(PCIA)。比较两组术后2、6、12、24、48 h的VAS评分(静息和咳嗽);比较两组患者术中丙泊酚、瑞芬太尼及顺阿曲库铵的用量、术后PCIA镇痛按压次数、追加补救镇痛给药次数、术后早期恢复质量指标及不良反应的发生情况。结果两组患者术后2 h到术后48 h的静息VAS评分和咳嗽时VAS评分先升高后下降,ESPB组VAS评分显著低于C组(P<0.05)。ESPB组瑞芬太尼及顺阿曲库铵的用量均少于C组(P<0.05),两组丙泊酚的用量差异无统计学意义(P>0.05)。ESPB组PCIA镇痛按压次数及追加补救镇痛给药次数均显著低于C组(P<0.05)。ESPB组恶心呕吐及皮肤瘙痒的发生率低于对照组(P<0.05),两组其余不良反应的发生率比较差异无统计学意义(P>0.05)。ESPB组首次下床时间及住院时间短于C组(P<0.05)。ESPB组医疗费用少于C组(P<0.05)。ESPB组术后1 d和2 d的QoR-40总评分明显高于C组(P<0.05)。结论超声引导下竖脊肌平面阻滞能为后入路腰椎手术提供良好、安全的镇痛,减少医疗费用,改善患者术后早期恢复质量。

Objective To evaluate the perioperative effect of ultrasound-guided erector spinal plane block(ES-PB)in posterior approach lumbar surgery and its influence on the quality of early postoperative recovery.Methods From August 2019 to July 2020,80 patients who underwent posterior approach lumbar surgery were randomly divided into ESPB group and control group(Group C)by random number table method(n=40).On the basis of conventional anes-thesia,ESPB was performed for erection spinal muscle plane block,and patients in both groups were given with post-op-erative controlled intravenous analgesia(PCIA).VAS scores(resting and cough)were compared between the two groups 2,6,12,24 and 48 hours after surgery.The intraoperative dosages of propofol,remifentanil and cisatacurium,the fre-quency of postoperative PCIA,the times of additional remedial analgesic administration,the quality indexes of early post-operative recovery and the occurrence of adverse reactions in the 2 groups were compared.Results The resting and cough VAS scores in 2 groups were firstly increased and then decreased from 2 hours to 48 hours after surgery,and the VAS scores in ESPB group were significantly lower than that in the control group(P<0.05).The dosages of remifentanil and cisatracurium in ESPB group were both significantly lower than those in the control group(P<0.05),while there was no significant difference in the dosage of propofol between the two groups(P>0.05).The PCIA count and additional reme-dial analgesic administration in ESPB group were significantly lower than those in control group(P<0.05).The inci-dence of adverse reactions in ESPB group was significantly lower than that in control group(P<0.05).The first time of getting out of bed and hospital stay in ESPB group were significantly shorter than those in control group(P<0.05).The medical expenses of ESPB group were significantly less than those of C group(P<0.05).The total QOR-40 scores of patients in both groups 1 and 2 days after surgery were significantly higher than those in the control group(P<0.05).Conclusion Ultrasound-guided erector spinal block can provide good and safe analgesia for posterior approach lumbar surgery,reduce medical costs and improve the quality of early postoperative recovery.