复合竖脊肌平面阻滞的多模式镇痛策略在腰椎后路手术中的应用

The application of multimodal analgesia strategy combined with erector spinae plane block in posterior lumbar surgery

目的:探究复合竖脊肌平面阻滞(ESPB)的多模式镇痛策略在腰椎后路手术中应用的临床效果。方法:选取择期行后路腰椎手术患者80例,采用随机数字表法随机分为ESPB组和非ESPB组各40例。ESPB组患者在全身麻醉后以每侧0.25%罗哌卡因20 mL行双侧竖脊肌平面阻滞,非ESPB组患者不进行ESPB。记录术后2、12、24和48 h静息和运动(翻身)的疼痛视觉模拟评分(VAS);记录阿片类药物用量、补救镇痛情况、首次按压镇痛泵时间;记录围手术期应激指标、术后恢复情况及不良反应发生情况。结果:与非ESPB组比较,ESPB组患者术后2、12 h静息和运动(翻身)VAS评分降低,阿片类药物用量减少,补救镇痛情况降低,首次按压镇痛泵时间延迟,围手术期血糖、血清皮质醇浓度降低,术后首次排气时间和首次下床时间缩短,患者满意度提高(P均<0.05),不良反应发生率差异无统计学意义(P>0.05)。结论:复合ESPB的多模式镇痛策略可减少围手术期阿片类药物用量、降低患者应激反应,可安全有效地应用于腰椎后路手术患者,利于患者术后康复。

Objective:To explore the clinical effect of a multimodal analgesic strategy combined with erector spinae plane block(ESPB)in posterior lumbar surgery.Methods:A total of 80 patients who underwent elective posterior lumbar surgery were selected and randomly divided into an ESPB group and a non-ESPB group,with 40 patients in each group,using a random number table method.Patients in the ESPB group underwent bilateral ESPB with 20 mL of 0.25%ropivacaine on each side after general anesthesia,and patients in the non-ESPB group did not undergo ESPB.Visual analogue scale(VAS)scores at rest and during movement(turning over)were recorded at 2,12,24 and 48 h postoperatively.The perioperative consumption of opioids,the numbers of remedial analgesia,time to the first press of analgesic pump,perioperative stress indicators,postoperative recovery,and occurrence of adverse events were recorded.Results:Compared with those in the non-ESPB group,patients in the ESPB group had lower VAS scores at rest and during movement(turning over)at 2 and 12 h postoperatively,reduced perioperative opioid consumption,fewer number of remedial analgesia,delayed first pressing of the analgesic pump,lower perioperative blood glucose and serum cortisol concentrations,shorter time to first postoperative exhaust and time to first postoperative ambulation,and higher levels of patient satisfaction(all P<0.05).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusions:The multimodal analgesia strategy combined with ESPB can reduce the perioperative consumption of opioids,and reduce the stress response of patients.It can be safely and effectively applied to patients undergoing posterior lumbar surgery,promoting postoperative recovery.