低浓度罗哌卡因超声引导骶管阻滞用于椎间孔镜下髓核摘除术的麻醉效果

Anesthetic effect of low concentration ropivacaine ultrasound-guided caudal block for percutaneous endoscopic lumbar discectomy

目的 本研究拟探讨低浓度罗哌卡因超声引导骶管阻滞用于椎间孔镜下髓核摘除术的麻醉效果。方法 本研究选择2021年5月—2023年5月该院接受经皮椎间孔镜下髓核摘除手术(PELD)患者60例,采用随机数字表法将患者分为阻滞组(R组)和局麻组(C组),每组30例。R组患者在手术前20min进行超声引导骶管阻滞,C组患者不实施骶管阻滞。二组患者均在局部麻醉下接受PELD术。记录二组患者入室基础(T0)、局部麻醉时(T1)、椎间孔成形时(T2)、置入工作通道时(T3)、髓核摘除时(T4)的平均动脉压和心率;记录二组患者T1、T2、T3、T4的疼痛VAS评分;记录二组患者利多卡因使用量、需要舒芬太尼补救镇痛例数;记录二组患者麻醉满意度;记录二组患者麻醉后48h内相关不良反应发生情况等。结果 二组患者不同时间点平均动脉压、心率比较差异均无统计学意义(P>0.05);R组患者在T1、T2、T3、T4时疼痛VAS评分较C组明显降低(P<0.05);R组患者利多卡因使用量和舒芬太尼补救镇痛例数较C组明显降低(P<0.05);R组患者麻醉满意度较C组明显升高(P<0.05);R组患者恶心呕吐发生率较C组明显降低(P<0.05)。结论 与局部麻醉比较,0.2%罗哌卡因20ml超声引导骶管阻滞联合局部麻醉用于椎间孔镜下髓核摘除术中镇痛效果更佳,降低疼痛VAS评分,减少局部麻醉利多卡因使用量,减少舒芬太尼使用和不良反应发生率,麻醉满意度更高。

Objective This study aims to explore the anesthesia effect of low concentration ropivacaine ultrasoundguided caudal block for percutaneous endoscopic lumbar discectomy.Methods We selected sixty patients who underwent percutaneous endoscopic lumbar discectomy in our hospital from May 2021 to May 2023.The patients were divided into group R and group C using a random number table method,with30 cases in each group.Group R patients underwent ultrasound-guided caudal block 20 minutes before PLED,while group C patients did not undergo caudal block.Both groups of patients underwent PELD surgery under local anesthesia.The average arterial pressure and heart rate of two groups of patients at baseline(T0),during local anesthesia(T1),during intervertebral foramen formation(T2),during insertion of the working channel(T3),and during nucleus pulposus removal(T4)were recorded.The pain VAS scores of T1,T2,T3 and T4in two groups of patients were recorded.The amount of lidocaine used and the number of patients needing sufentanil for rescue analgesia were recorded in two groups.Two groups of patients'satisfaction with anesthesia were recorded.The occurrence of related adverse reactions within48 hours after anesthesia in two groups of patients was recorded.Results There was no statistically significant difference in average arterial pressure and heart rate between the two groups of patients at different time points(P>0.05).The pain VAS scores of patients in Group R were significantly lower than those in group C at T1,T2,T3,and T4(P<0.05).The amount of lidocaine used and the number of sufentanil rescue analgesia cases in group R were significantly lower than those in group C(P<0.05).The satisfaction with anesthesia in group R was significantly higher than that in group C(P<0.05).The incidence of nausea and vomiting in group R was significantly lower than that in group C(P<0.05).Conclusion Compared with local anesthesia,0.2%ropivacaine 20ml ultrasound-guided caudal block combined with local anesthesia for intraforaminal nucleus pulposus extraction has better analgesic effect,lower pain VAS score,reduce the use of local anesthesia lidocaine,reduce the use of sufentanil and the incidence of adverse reactions,and have higher anesthesia satisfaction.