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| 竖脊肌平面阻滞与后路椎板阻滞对后路腰椎手术术后镇痛效果的比较 | |
| 引用本文： | 陶涛,周全. 竖脊肌平面阻滞与后路椎板阻滞对后路腰椎手术术后镇痛效果的比较[J]. 南方医科大学学报, 2019, 39(6): 736. DOI: 10.12122/j.issn.1673-4254.2019.06.17 |
| 作者姓名： | 陶涛 周全 |
| 作者单位： | 湛江中心人民医院麻醉科,广东湛江,524045;湛江中心人民医院麻醉科,广东湛江,524045 |
| 摘 要： | 目的回顾性分析竖脊肌平面阻滞（ESPB）与后路椎板阻滞（RLB）对后路腰椎手术术后急性疼痛的影响。方法回顾性分析2018年01月~2018年12月于我院行择期后路腰椎手术患者89例。其中，对照组30例，采用全凭静脉麻醉；ESPB组28例，采用全凭静脉复合ESPB麻醉；RLB组31例，采用全凭静脉麻醉复合RLB麻醉。分别于术前和术后2、8、12、24、48 h对患者进行VAS评分，记录患者术中和术后静脉镇痛舒芬太尼消耗量及术后48 h内恶心呕吐、瘙痒和呼吸抑制等并发症发生情况。结果ESPB组和RLB组患者VAS评分在术后2、8和12 h 3个时间点显著低于对照组，而RLB组又低于ESPB组，差异具有统计学意义（P<0.05）。与对照组相比，ESPB组和RLB组术中和术后静脉镇痛舒芬太尼消耗均显著减少，并且RLB组少于ESPB组，差异具有统计学意义（P<0.05）。对照组出现2例恶心呕吐和1例瘙痒，ESPB组出现1例镇静过度和1例尿潴留，RLB组出现1例尿潴留。结论在后路腰椎手术围术期疼痛管理中，超声引导下RLB较ESPB具有更好的镇痛效果。 |
| 关 键 词： | 竖脊肌平面阻滞 后路椎板阻滞 术后急性疼痛 |
Efficacy of erector spinae block versus retrolaminar block for postoperative analgesiafollowing posterior lumbar surgery |
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| Abstract: | Objective To compare the effect of erector spinae plane block and retrolaminar block for relieving acute pain afterposterior lumbar surgery. Methods Eighty-nine patients undergoing selective posterior lumbar surgery under generalanesthesia in our hospital between January and December, 2018, were recruited. Of these patients, 30 received totalintravenous general anesthesia to serve as the control group, 28 received total intravenous general anesthesia (TIVA) combinedwith erector spinae plane block (ESPB), and 31 had TIVA combined with retrolaminar block (RLB). All the patients receivedpatient-controlled intravenous analgesia (PCIA) for postoperative analgesia, and their heart rate, blood pressure, and pulseoximetry were routinely monitored during the anesthesia. VAS scores were evaluated before and at 2, 8, 12, 24, and 48 h afterthe surgery. Sufentanil consumption during the operation and PCIA were also recorded. The postoperative complications suchas nausea and vomiting, urinary retention, itching and respiratory depression within 48 h after the surgery were also recorded.Results At 2, 8 and 12 h postoperatively, VAS scores in the ESPB group and RLB group were significantly lower than those inthe control group; the scores were significantly lower in RLB group than in ESPB group (P<0.05). Compared with that in thecontrol group, sufentanil consumption during the operation and PCIA were significantly decreased in both ESPB and RLBgroups, particularly in the latter group (P<0.05). Two patients experienced nausea and vomiting and 1 patient complained ofpruritus in control group; 1 patient had over sedation and 1 had urinary retention in ESPB group; 1 patient had urinaryretention in RLB group. Conclusion Ultrasound-guided RLB has better analgesic effect than ESPB for management ofperioperative pain following posterior lumbar surgery. |
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