超声引导下胸腰筋膜平面阻滞对单节段腰椎骨折术后静脉镇痛的影响  

Effect of ultrasound-guided thoracolumbar interfascial plane block on postoperative analgesia in single lumbar spine surgery

作　　者：程传喜 王继霜 周密[1] CHENG Chuanxi;WANG Jishuang;ZHOU Mi(Department of Anesthesiology,the People’s Hospital of China Three Gorges University & the First People’s Hospital of Yichang,Yichang 443000,China)

机构地区：[1]三峡大学人民医院宜昌市第一人民医院麻醉科

出　　处：《临床麻醉学杂志》2019年第9期854-857,共4页Journal of Clinical Anesthesiology

摘　　要：目的评估超声引导下胸腰筋膜平面阻滞在腰椎手术中应用的安全性和有效性。方法选择2017年8月-2018年8月拟在全麻下行单节段腰椎手术患者48例,男女各24例,年龄18~65岁,BMI 18~25 kg/m2,ASAⅠ-Ⅲ级。随机分为胸腰筋膜阻滞组(EG组)和对照组(CG组)。EG组在L3平面超声引导下分别于双侧胸腰筋膜注入0.375%罗哌卡因20 ml,CG组未行胸腰筋膜阻滞。术后均行舒芬太尼PCIA,无背景剂量。记录术中瑞芬太尼和术后舒芬太尼、氟比洛芬酯用量,术后2、6、12、24 h的VAS疼痛评分,术后PCIA有效按压次数,以及术后恶心呕吐、颜面部水肿、低体温等不良反应发生情况。结果 EG组术中瑞芬太尼用量[(1 041.5±104.3)μg vs (1147.6±158.2)μg]、术后舒芬太尼用量[(32.5±7.2)μg vs (72.6±13.2)μg]、术后氟比洛芬酯用量[(18.5±3.7)mg vs (40.3±5.3)mg]、术后PCIA有效按压次数[(9.2±2.7)次vs (23.1±3.1)次]明显少于CG组(P<0.05)。EG组术后2、6、12、24 h的VAS评分明显低于CG组(P<0.05)。EG组患者术后恶心呕吐发生率明显低于CG组(P<0.05)。两组颜面部水肿和低体温发生率差异无统计学意义。结论超声引导下胸腰筋膜平面阻滞在腰椎手术中的应用安全有效,同时减少了术中和术后阿片类药物的用量,有效缓解患者术后短期疼痛,并减少术后相关并发症。Objective To evaluate the safety and efficacy of ultrasound-guided thoracolumbar interfascial plane(TLIP) block in lumbar spine surgery. Methods Forty-eight patients undergoing single lumbar surgery under general anesthesia from August 2017 to August 2018 were selected,24 males and 24 females, aged 18-65 years, BMI 18-25 kg/m^2, falling into ASA physical status Ⅰ-Ⅲ. The patients were divided into two groups. Patients in the experimental group(group EG) were injected 20 ml of 0.375% ropivacaine into the thoracolumbar interfascial plane under the ultrasound-guidance at the level of the third lumbar vertebra in each side. Patients in the control group(group CG) did not have thoracolumbar fascia block. All patients received patient-controlled intravenous analgesia(PCIA). The patient’s postoperative sufentanyl, remifentanil dosage, flurbiprofen consumption, pain VAS score within 24 h, pressing times of PCIA pump, nausea and vomiting, facial edema, hypothermy and other complications were recorded. Results Compared with group CG, the dosage of sufentanyl(32.5 ± 7.2 μg vs 72.6 ± 13.2 μg) and remifentanil(1 041.5 ± 104.3 μg vs 1 147.6 ± 158.2 μg) and the consumption of flurbiprofen(18.5 ± 3.7 mg vs 40.3 ± 5.3 mg) was significantly lower in group EG(P < 0.05), the pressing times of PCIA pump was significantly less in group EG(P < 0.05), the VAS scores of 2, 6, 12 and 24 h was significantly lower in group EG(P < 0.05). And the incidence of nausea and vomiting was significantly lower in the group EG(P < 0.05). There was no statistically significant difference in facial edema, hypothermia and other complications between the two groups. Conclusion The application of TLIP block in lumbar spine surgery is safe and effective. It effectively relieves the pain within 24 h after operation, and reduces the related complications after operation while reducing the dosage of opioids.

关 键 词：胸腰筋膜平面阻滞 超声引导 术后镇痛 腰椎手术 

分 类 号：R614[医药卫生—麻醉学]