竖脊肌平面阻滞对腰椎后路手术患者术后早期康复的影响

目的评价超声引导下竖脊肌平面阻滞(erector spine plane block,ESPB)对腰椎后路手术患者术后早期康复的影响。方法择期全麻下行腰椎手术的患者65例,年龄45~65岁,性别不限,ASA分级I或Ⅱ级,体质量指数(BMI)18.5~28.0 kg/m 2,采用随机数字表法分为超声引导竖脊肌平面阻滞组(ESPB组,32例)和对照组(GA组,33例)。2组均采用静-吸复合麻醉,术后采用舒芬太尼行静脉自控镇痛(PCIA)。ESPB组全麻诱导前于俯卧位行竖脊肌平面阻滞。当VAS评分≥4分时,肌内注射曲马多补救镇痛。分别于术前1 d,术后第1天、2天时,采用QoR-15量表评估患者恢复质量。记录术后1 h、6 h、12 h、24 h、48 h的VAS评分,术后48 h内PCIA舒芬太尼用量、补救镇痛情况和恶心及呕吐发生情况。结果与GA组相比,ESPB组术后第1天、2天时QoR-15评分升高,术后1 h、6 h和12 h VAS评分降低,PCIA舒芬太尼用量减少,补救镇痛率和术后恶心呕吐发生率降低。以上差异均有统计学意义(P<0.05)。结论超声引导竖脊肌平面阻滞可促进腰椎后路手术患者术后早期康复。

Effect of erector spinae plane block on early postoperative rehabilitation of patients with lumbar posterior surgery

Objective To evaluate the effect of ultrasound-guided erector spinae plane block(ESPB)on early postoperative rehabilitation of patients undergoing lumbar posterior surgery.Methods Sixty-five patients of both sexes,aged 45~65 years,with body mass index of 18.5~28.0 kg/m 2,American Society Anesthesiologists physical status I orⅡ,undergoing lumbar surgery with general anesthesia,were divided into 2 groups using a random number table method:erector spinae plane block group(group ESPB,n=32)and control group(group GA,n=33).Patients in the group ESPB received ultrasound-guided ESP block in prone position before general anesthesia whereas those in group GA received only general anesthesia.All patients received patient-controlled intravenous analgesia with sufentanil after surgery.Tramadol was intramuscularly injected as rescue analgesia when visual analog scale score≥4.Quality of Recovery-15 questionnaire was used to assess the quality of recovery at 1 day before surgery and 1 and 2 days after operation.The VAS scores at 1,6,12,24 and 48h after operation,consumption of postoperative sufentanil,requirement for rescue analgesics and development of nausea and vomiting were recorded.Results Compared with group GA,the Quality of Recovery-15 questionnaire scores were significantly increased at 1 and 2 days after surgery;the VAS scores at 1,6 and 12h were decreased after surgery;consumption of postoperative sufentanil was reduced and the requirement for rescue analgesics and incidence of nausea and vomiting were decreased in group ESPB(P<0.05).Conclusion Ultrasound-guided erector spine plane block can promote early postoperative recovery of patients with lumbar posterior surgery.