超声引导下改良胸腰椎筋膜间平面阻滞与切口浸润治疗腰椎手术后疼痛的比较

Comparison of ultrasound-guided modified thoracolumbar fascial plane block and incision infiltration in the treatment of postoperative pain of lumbar spine surgery

目的 探讨超声引导下改良胸腰椎筋膜间平面(mTLIP)阻滞与切口浸润对腰椎手术后疼痛的影响。方法选择接受全麻下腰椎间盘突出症手术的74例患者,采用随机数字表法将患者分为mTLIP组和切口浸润组,分别给予mTLIP和切口浸润镇痛。观察两组患者术后1 h、8 h、24 h时视觉模拟疼痛评分(VAS)和阿片类药物用量,并比较并发症发生情况。结果 mTLIP组患者在术后1 h、8 h时静息VAS评分和活动VAS评分均低于切口浸润组,差异均有统计学意义(t分别=3.88、3.48、2.91、2.34,P均<0.05);术后24 h时,两组患者静息VAS评分和活动VAS评分比较,差异均无统计学意义(t分别=0.41、0.66,P均>0.05)。mTLIP组患者补救性镇痛发生率低于伤口浸润组,差异有统计学意义(χ^(2)=7.31,P<0.05)。mTLIP组患者术后1 h、8 h、24 h时阿片类药物用量均低于切口浸润组,差异均有统计学意义(t分别=3.07、6.11、8.28,P均<0.05)。两组患者均未发生呼吸抑制、嗜睡、尿潴留等不良反应,mTLIP组恶心呕吐和瘙痒发生率均低于切口浸润组,差异均有统计学意义(χ^(2)分别=7.14、4.55,P均<0.05)。结论mTLIP阻滞在腰椎间盘手术后的最初8 h镇痛效果优于切口浸润,可能是腰椎手术后疼痛管理的切口浸润的一种良好替代方法。

Objective To study the effect of ultrasound-guided modified thoracolumbar fascial plane block(mTLIP) and incision infiltration on pain after lumbar surgery. Methods A total of 74 patients who underwent lumbar disc herniation surgery under general anesthesia were randomly divided into mTLIP group and incision infiltration group,and they were received mTLIP and incision infiltration analgesia respectively.The visual analogue scale(VAS)and the dosage of opioids were observed at 1h,8h and 24h after operation,and the complications were compared between the two groups.Results The resting VAS and active VAS in mTLIP group were lower than those in incision infiltration group at 1h and 8h after operation,and the difference was statistically significant(t=3.88,3.48,2.91,2.34,P<0.05).At 24 hours after operation,there was no significant difference in resting VAS and active VAS between the two groups(t=0.41,0.66,P>0.05).The incidence of remedial analgesia in mTLIP group was lower than that in incision infiltration group,and the difference was statistically significant(χ^(2)=7.31,P<0.05).The dosage of opioids in mTLIP group was lower than that in incision infiltration group at 1h,8h and 24h after operation,and the difference was statistically significant(t=3.07,6.11,8.28,P<0.05).There were no adverse reactions such as respiratory depression,sleepiness and urinary retention in the two groups.The incidence of nausea and vomiting,pruritus in mtlip group were lower than that in incision infiltration group(χ^(2)=7.14,4.55,P<0.05). Conclusion mTLIP block has better analgesic effect than incision infiltration in the first 8 hours after lumbar disc surgery,which may be a good alternative to incision infiltration in pain management after lumbar surgery.