改良胸腰筋膜间平面阻滞对腰椎减压融合术患者术后恢复质量的影响

Effect of modified thoracolumbar interfascial plane block on postoperative quality of recovery in patients undergoing lumbar decompression and fusion

目的探讨超声引导下改良胸腰筋膜间平面阻滞对腰椎减压融合术患者术后恢复质量的影响。方法择期全麻下行腰椎减压融合术患者60例,采用随机数字表法分为改良胸腰筋膜间平面神经阻滞组(T组)和对照组(C组),每组30例。T组在超声引导下两侧第三腰椎水平髂肋肌和最长肌之间各注射0.4%罗哌卡因20 mL+20μg右美托咪定,C组不予神经阻滞。术毕2组均采用患者自控静脉镇痛(PCIA)。当患者术后数字疼痛评分(NRS)≥4分,静脉给予氟比洛芬酯50 mg进行补救性镇痛。记录2组患者术前和术后24 h的15项恢复质量评分量表(QoR-15)评分;2组患者术后0.5、2、6、12、24、48 h的NRS评分;术后24 h内静息时和活动时NRS评分随时间变化曲线下面积(AUC);术后24 h患者满意度评分、PCIA按压次数及采用补救性镇痛情况,术后恶心呕吐等不良反应的发生情况。结果与C组比较,T组患者术后24 h的QoR-15评分升高,患者满意度评分升高,术后0.5、2、12、24、48 h静息时及活动时NRS评分降低,术后24 h静息时和活动时NRS评分的AUC降低、PCIA按压次数减少、补救性镇痛率降低(P<0.05)。结论超声引导下右美托咪定复合罗哌卡因改良胸腰筋膜间平面神经阻滞能够提高腰椎减压融合术患者的术后恢复质量,缓解术后疼痛,提高其满意度,有助于促进患者术后早期康复。

Objective To evaluate the effect of ultrasound-guided modified thoracolumbar interfascial plane(mTLIP)block on the quality of recovery(QoR)in patients undergoing lumbar decompression and fusion.Methods Sixty patients undergoing lumbar decompression and fusion were divided into two groups(n=30)by a random number table method:the mTLIP block group(group T)and the control group(group C).The patients in the group T were injected with 0.4%ropivacaine 20 mL+20μg dexmedetomidine between longissimus and iliocostalis muscles at the third lumbar spine vertebral level on each side under ultrasound guidance,while patients in the group C were not received nerve block.All patients received patient controlled intravenous analgesia(PCIA)after operation.When patients had a postoperative pain numerical rating scale(NRS)≥4,flurbiprofen ester 50 mg was given intravenously for remedial analgesia.The QoR-15 scores of patients in both groups were recorded before and 24 hours after operative.The NRS scores for pain in both groups were recorded at 0.5,2,6,12,24 and 48 hours postoperatively.The area under curve(AUC)of NRS scores at rest and at activity at 24 hours after surgery,the patient satisfaction scores,PCI A press times and the use of remedial analgesia at 24 h after operation,postoperative nausea and vomiting were also recorded.Results Compared with the group C,patients in the group T had higher QoR-15 scores at 24 hours postoperatively,higher patient satisfaction scores,lower NRS scores at rest and at activity at 0.5 h,2 h,12 h,24 h and 48 h postoperatively,lower AUC,fewer PCI A press times and lower rate of remedial analgesia at rest and at activity(P<0.05).Conclusion Ultrasound-guided dexmedetomidine compounded with ropivacaine for modified thoracolumbar fascial plane nerve block can improve the quality of postoperative recovery in patients undergoing lumbar decompression and fusion,relieve postoperative pain,improve patient satisfaction and promote early postoperative recovery.