双侧竖脊肌平面阻滞在腰椎后入路手术后的镇痛效果观察

Observation on the Analgesic Effect of Bilateral Erector Ridge Muscle Plane Block after Lumbar Posterior Approach Surgery

目的:分析双侧竖脊肌平面阻滞用在腰椎后入路手术后的镇痛效果。方法:选取萍乡市中医院2021年7月—2023年7月萍乡市中医院入院诊断为腰椎退行性疾病或腰椎骨折患者,需要手术治疗60例作为研究对象。按随机数字表法分为观察组和对照组,各30例。对照组选择静吸复合全身麻醉,观察组选择超声引导下双侧竖脊肌平面阻滞+静吸复合全身麻醉,两组术后都安装静脉自控镇痛泵。对比两组术中术后阿片类药物和术中肌松药物的使用量,根据视觉模拟评分法(visual analogue scale,VAS)对比两组患者术后6、12、24、48 h随访中疼痛的分数,记录术后患者自控按压镇痛泵补救性镇痛给药次数及不良反应。结果:观察组术中术后使用的舒芬太尼、术中瑞芬太尼、术中阿曲库铵药物用量均少于对照组(P<0.05)。观察组各时间段术后VAS评分均比对照组低(P<0.05)。术后补救性镇痛给药次数少于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下双侧竖脊肌平面阻滞在腰椎后入路手术患者中的镇痛效果更好,既减少了阿片类药物、肌松药物的使用,又减轻了患者术后的疼痛,患者术后静脉补救性镇痛给药次数和不良反应减少,临床应用安全可靠。

Objective:To analyze the analgesic effect of bilateral erector ridge muscle plane block after lumbar posterior approach surgery.Method:A total of 60 patients who were admitted to Pingxiang Hospital of Traditional Chinese Medicine from July 2021 to July 2023 and were diagnosed as lumbar degenerative diseases or lumbar fracture and required surgical treatment were selected as the study subjects.They were divided into observation group and control group by random number table method,with 30 cases in each group.The control group was given combined intravenous and inhalation general anesthesia,and the observation group was given ultrasound-guided bilateral erector ridge muscle plane block+combined intravenous and inhalation general anesthesia,both groups were equipped with intravenous self controlled analgesia pumps after surgery.Intraoperative and postoperative opioid and intraoperative muscle relaxants were compared between the two groups,and pain scores in 6,12,24 and 48 h postoperative follow-up were compared between the two groups according to visual analogue scale(VAS),the number of therapeutic analgesia administration of patient-controlled analgesic pump and adverse reactions were recorded.Result:The amount of Sufentanil used during and after surgery,Remifentanil and Atracurium used during surgery in the observation group were less than those in the control group(P<0.05).The postoperative VAS scores of the observation group were lower than those of the control group at all time periods(P<0.05).The number of postoperative remedial analgesic doses was less than that of the control group,the difference was statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion:Ultrasonic-guided bilateral erector ridge muscle plane block has better analgesic effect in patients undergoing lumbar posterior approach surgery,which not only reduces the use of opioids and muscle relaxers,but also reduces postoperative pain.The number of postoperative intravenous analgesia administration and adverse reactions of patients are reduced,and the clinical application is safe and reliable.