双侧T12竖脊肌平面阻滞对腰椎手术镇痛效果观察:一项前瞻性、双盲、随机对照试验  

Analgesic efficacy of bilateral erector spinae plane block on T12 for lumbar spine surgery:A prospective,double-blind,randomized,controlled trail

作　　者：杜杰强 罗瑞敏 陈路 游玉媛[1] 黄应思 Du Jieqiang;Luo Ruimin;Chen Lu(Department of Anesthesiology,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]佛山市中医院麻醉科,528000 [2]佛山市中医院关节科,528000 [3]解放军总医院海南医院麻醉科

出　　处：《中华保健医学杂志》2024年第4期508-510,共3页Chinese Journal of Health Care and Medicine

基　　金：佛山市卫生健康局医学科研课题(20220267)。

摘　　要：目的 探讨双侧第12胸椎水平(T12)行竖脊肌平面阻滞(ESPB)对腰段脊柱手术的镇痛效果有效性的研究。方法 前瞻性选取2022年3月~2022年7月在佛山市中医院手术中心行后路腰椎切开复位融合内固定手术治疗的患者60例,随机数表法将患者分成观察组(30例)及对照组(30例)。观察组有2名患者中途退出。观察组患者术前30 min于双侧T12竖脊肌平面给予0.3%罗哌卡因各30 ml。对照组患者给予0.9%生理盐水各30 ml。主要观察指标为术中舒芬太尼追加量。次要观察指标为患者在麻醉恢复室(PACU)拔管后舒芬太尼追加量、术后(拔管后即刻、出PACU时、术后2、12和24 h)疼痛视觉模拟量表(VAS)评分。结果 观察组术中和PACU中舒芬太尼追加量明显少于对照组,差异有统计学意义(Z=2.446、3.092,P<0.05)。观察组拔管后即刻和离开PACU时VAS评分观察组明显低于对照组,差异有统计学意义(Z=4.163、3.347,P<0.05)。两组患者术后12和24 h的VAS评分和舒芬太尼使用量差异无统计学意义(Z=1.084、0.658、0.329、0.765,P> 0.05)。结论 双侧T12 ESPB能为术中及PACU中提供有效镇痛。Objective To investigate the analgesic efficacy of bilateral T12 erector spinae plane block in lower lumbar spine surgery.Methods 60 patients undergoing lumber spine surgery with general anesthesia were included.All patients met the inclusion criteria.They were randomly divided into two groups:Group E and Group C.2 Patients in Group E dropped out the trail and 58 patients were finally enrolled in this trail.Patients in group E(n=28)received bilateral erector spinae plane block at T12 with 30 ml of 0.3%ropivacaine for each side 30 minutes before the surgery.Patients in group C(n=30)received 0.9%30 ml saline for each side 30 minutes before the surgery.The primary outcome was sufentanil consumption during the surgery.Secondary outcomes included 2 indicators.The first indicator included sufentanil consumption in the postoperative anesthesia recovery room(PACU)and 12 h,24 h after the surgery.The second indicator was visual analogue scale(VAS)score performing at the time of after tracheal extubating immediately,leaving PACU,and 12 h,24 h after the surgery.Results Sufentanil consumption during the surgery in group E was significantly lower than in group C(Z=2.446,P=0.014).Compared with group C,immediate VAS score after tracheal extubating in group E was significantly lower(Z=4.163,P<0.001).When leaving the PACU,VAS score in group E was significantly lower than in group C(Z=3.347,P=0.001).Meanwhile,sufentanil consumption in group E was also distinctly lower than in group C at the time of leaving PACU(Z=3.092,P=0.002).There were no differences in VAS scores at the time of 12 h and 24 h after the surgery between the two groups(Z=1.084,0.658,P=0.278,0.551).Sufentanil consumption at the time of 12 h and 24 h after the surgery between group E and group C didn’t show any statistical difference(Z=0.329,0.765,P=0.742,0.444).Conclusion Bilateral T12 erector spinae plane block can provide effective analgesia during operation and in PACU.

关 键 词：竖脊肌平面阻滞 腰椎手术 超声引导 围术期镇痛 

分 类 号：R614[医药卫生—麻醉学]