地佐辛复合罗哌卡因行竖脊肌平面阻滞对腰椎手术患者术后镇痛、应激反应和早期恢复质量的影响

Effects of dezocine combined with ESPB on postoperative analgesia,stress response and early recovery quality in patients undergoing posterior lumbar surgery

目的:探讨地佐辛复合罗哌卡因行竖脊肌平面阻滞(ESPB)对腰椎手术患者术后镇痛、应激反应和早期恢复质量的影响。方法:将接受腰椎手术的82例患者按照麻醉方式不同分为对照组与地佐辛组,每组各41例。两组在麻醉诱导前均实施ESPB,其中对照组予以0.4%罗哌卡因20 mL注入;地佐辛组予以0.1 mg/kg地佐辛+0.4%罗哌卡因组成的混合药液20 mL注入。术毕,两组均予以静脉泵镇痛。记录并比较两组患者术后2、6、12及24 h的疼痛评分;记录并比较术后48 h内镇痛情况;分别于术前及术后24 h,检测患者血清促肾上腺皮质激素(ACTH)、皮质醇(Cor)水平;于术后24 h和术后48 h,使用进食时间与15项恢复质量量表(QoR-15)对患者恢复质量进行评估;记录并比较患者术后48 h镇痛相关不良反应。结果:与对照组比较,地佐辛组术后2~24 h疼痛评分显著下降(P<0.05);术后48 h内镇痛泵按压次数减少(P<0.05);舒芬太尼用量降低(P<0.05);补救镇痛率更低(P<0.05);术后24 h ACTH水平和Cor水平更低(P<0.05);术后进食时间提前,术后24、48 h的QoR-15评分增高(P<0.05),术后48 h内恶心呕吐发生率更低(P<0.05)。结论:地佐辛复合罗哌卡因ESPB用于腰椎手术中,可提高患者术后镇痛效果,减轻应激反应,改善术后早期恢复质量。

Objective:To investigate the effects of dezocine combined with ropivacaine for erector spinae plane block(ESPB)on postoperative analgesia,stress response and early recovery quality in patients undergoing posterior surgery.Methods:A total of 82 patients undergoing lumbar surgery were divided into control group and dezocine group according to different anesthesia methods,with 41 cases in each group.ESPB was performed in both groups before anesthesia induction.The control group was injected with 20 mL of 0.4%ropivacaine,and the dezocine group was injected with 20 mL of mixed liquid composed of 0.1 mg/kg dezocine+0.4%ropivacaine.At the end of operation,both groups were given intravenous pump analgesia.The pain scores of the two groups at 2,6,12 and 24 h after operation and analgesia within 48 hours after operation were recorded and compared.The levels of serum adrenocorticotropic hormone(ACTH)and cortisol(Cor)were detected before operation and 24 h after operation.At 24 h and 48 h after surgery,the quality of recovery was assessed using the 15-item quality of recovery scale(QoR-15).In addition,the adverse reactions related to analgesia 48 h after operation were recorded.Results:Compared with the control group,the pain score of the dezocine group was significantly decreased at 2~24 h after operation(P<0.05).Compared with the control group,the number of analgesic pump compressions within 48 hours after operation decreased in the dezocine group(P<0.05),the dosage of sufentanil decreased(P<0.05),and the remedial analgesia rate decreased(P<0.05).Compared with the control group,the levels of ACTH and Cor in the dezocine group were lower at 24 h after operation(P<0.05).Compared with the control group,the time for postoperative eating advanced,the QoR-15 score of the dezocine group increased at 24 and 48 h after operation(P<0.05),and the incidence of nausea and vomiting in the dezocine group decreased within 48 hours after operation(P<0.05).Conclusion:Dezocine combined with ropivacaine ESPB in lumbar surgery can improve the postoperative analgesic effect,reduce the stress response and improve the quality of early postoperative recovery.