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
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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。
Objective To compare the effect of erector spinae plane block and retrolaminar block for relieving acute pain after posterior lumbar surgery. Methods Eighty-nine patients undergoing selective posterior lumbar surgery under general anesthesia in our hospital between January and December, 2018, were recruited. Of these patients, 30 received total intravenous general anesthesia to serve as the control group, 28 received total intravenous general anesthesia(TIVA) combined with erector spinae plane block(ESPB), and 31 had TIVA combined with retrolaminar block(RLB). All the patients received patient-controlled intravenous analgesia(PCIA) for postoperative analgesia, and their heart rate, blood pressure, and pulse oximetry were routinely monitored during the anesthesia. VAS scores were evaluated before and at 2, 8, 12, 24, and 48 h after the surgery. Sufentanil consumption during the operation and PCIA were also recorded. The postoperative complications such as 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 in the control group; the scores were significantly lower in RLB group than in ESPB group(P<0.05). Compared with that in the control group, sufentanil consumption during the operation and PCIA were significantly decreased in both ESPB and RLB groups, particularly in the latter group(P<0.05). Two patients experienced nausea and vomiting and 1 patient complained of pruritus in control group; 1 patient had over sedation and 1 had urinary retention in ESPB group; 1 patient had urinary retention in RLB group. Conclusion Ultrasound-guided RLB has better analgesic effect than ESPB for management of perioperative pain following posterior lumbar surgery.
Objective To compare the effect of erector spinae plane block and retrolaminar block for relieving acute pain after posterior lumbar surgery. Methods Eighty-nine patients undergoing selective posterior lumbar surgery under general anesthesia in our hospital between January and December, 2018, were recruited. Of these patients, 30 received total intravenous general anesthesia to serve as the control group, 28 received total intravenous general anesthesia(TIVA) combined with erector spinae plane block(ESPB), and 31 had TIVA combined with retrolaminar block(RLB). All the patients received patient-controlled intravenous analgesia(PCIA) for postoperative analgesia, and their heart rate, blood pressure, and pulse oximetry were routinely monitored during the anesthesia. VAS scores were evaluated before and at 2, 8, 12, 24, and 48 h after the surgery. Sufentanil consumption during the operation and PCIA were also recorded. The postoperative complications such as 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 in the control group; the scores were significantly lower in RLB group than in ESPB group(P<0.05). Compared with that in the control group, sufentanil consumption during the operation and PCIA were significantly decreased in both ESPB and RLB groups, particularly in the latter group(P<0.05). Two patients experienced nausea and vomiting and 1 patient complained of pruritus in control group; 1 patient had over sedation and 1 had urinary retention in ESPB group; 1 patient had urinary retention in RLB group. Conclusion Ultrasound-guided RLB has better analgesic effect than ESPB for management of perioperative pain following posterior lumbar surgery.
引文
[1] Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block:A Novel Analgesic Technique in Thoracic Neuropathic Pain[J]. Reg Anesth Pain Med, 2016, 41(5):621-7.
[2] Ueshima H, Otake H. Clinical experiences of ultrasound-guided erector spinae plane block for thoracic vertebra surgery[J]. J Clin Anesth, 2017, 38:137.
[3] Melvin JP, Schrot RJ, Chu GM, et al. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery:a case series[J]. Can J Anaesth, 2018, 65(9):1057-65.
[4]Tulgar S, Kose HC, Selvi O, et al. Comparison of ultrasound-guided lumbar erector spinae plane block and transmuscular quadratus lumborum block for postoperative analgesia in hip and proximal femur surgery:a prospective randomized feasibility study[J]. Anesth Essays Res, 2018, 12(4):825-31.
[5] Pfeiffer G, Oppitz N, Schone S, et al. Analgesia of the axilla using a paravertebral catheter in the lamina technique[J]. Anaesthesist, 2006,55(4):423-7.
[6] Jüttner T, Werdehausen R, Hermanns H, et al. The paravertebral lamina technique:a new regional anesthesia approach for breast surgery[J]. J Clin Anesth, 2011, 23(6):443-50.
[7] Yoshida H, Yaguchi S, Matsumoto A, et al. A modified paravertebral block to reduce risk of mortality in a patient with multiple rib fractures[J]. Am J Emerg Med, 2015, 33(5):733-5.
[8] Ueshima H, Hara E, Otake H. Lumbar vertebra surgery performed with a bilateral retrolaminar block[J]. J Clin Anesth, 2017, 37:114.
[9] Nagane D, Ueshima H, Otake H. Upper lobectomy of the left lung using a left retrolaminar block[J]. J Clin Anesth, 2018, 49:74.
[10]Bianconi M, Ferraro L, Ricci R, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery[J]. Anesth Analg, 2004, 98(1):166-72.
[11]Mcgirt M J, Bydon M, Archer KR, et al. An analysis from the quality outcomes fatabase, part 1. disability, quality of life, and pain outcomes following lumbar spine surgery:predicting likely individual patient outcomes for shared decision-making[J]. J Neurosurg Spine, 2017, 27(4):357-69.
[12]Kim DK, Yoon SH, Kim JY, et al. Comparison of the effects of sufentanil and fentanyl intravenous patient controlled analgesia after lumbar fusion[J]. J Korean Neurosurg Soc, 2017, 60(1):54-9.
[13]Benyahia NM, Verster A, Saldien V, et al. Regional anaesthesia and postoperative analgesia techniques for spine surgery-a review[J].Rom J Anaesth Intensive Care, 2015, 22(1):25-33.
[14]Singh S, Chaudhary NK. Bilateral ultasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery[J]. J Neurosurg Anesthesiol, 2019:1.
[15]Zeballos JL, Voscopoulos C, Kapottos M, et al. Ultrasound-guided retrolaminar paravertebral block[J]. Anaesthesia, 2013, 68(6):649-51.
[16]孙天胜,沈建雄,刘忠军,等.中国脊柱手术加速康复——围术期管理策略专家共识[J].中华骨与关节外科杂志, 2017, 10(4):271-9.
[17]Zhu Q, Li L, Yang Z, et al. Ultrasound guided continuous quadratus lumborum block hastened recovery in patients undergoing open liver resection:a randomized controlled, open-label trial[J]. BMC Anesthesiol, 2019, 19(1):23.
[18]Dang L, Chen Z, Liu X, et al. Lumbar disk herniation in children and adolescents:the significance of configurations of the lumbar spine[J]. Neurosurgery, 2015, 77(6):954-9.
[19]Stromqvist F, Stromqvist B, Jonsson B, et al. Surgical treatment of lumbar disc herniation in different ages-evaluation of 11,237 patients[J]. Spine J, 2017, 17(11):1577-85.
[20]Damjanovska M, Pintaric TS, Cvetko E, et al. The ultrasound-guided retrolaminar block:volume-dependent injectate distribution[J]. J Pain Res, 2018, 11:293-9.
[21]Sabouri AS, Crawford L, Bick SK, et al. Is a retrolaminar approach to the thoracic paravertebral space possible:a human cadaveric study[J]. Reg Anesth Pain Med, 2018, 1.
[22]Ueshima H, Hara E, Otake H. Lumbar vertebra surgery performed with a bilateral retrolaminar block[J]. J Clin Anesth, 2017, 37:114.
[23]Yang HM, Choi YJ, Kwon HJ, et al. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region:a cadaveric study[J].Anaesthesia, 2018, 73(10):1244-50.
[24]Murouchi T. Consideration of block nomenclature:erector spinae plane block or retrolaminar block[J]? Reg Anesth Pain Med, 2017, 42(1):124.
[25]Adhikary SD, Bernard S, Lopez H, et al. Erector spinae plane block versus retrolaminar block:a magnetic resonance imaging and anatomical study[J]. Reg Anesth Pain Med, 2018, 43(7):756-62.
[2] Ueshima H, Otake H. Clinical experiences of ultrasound-guided erector spinae plane block for thoracic vertebra surgery[J]. J Clin Anesth, 2017, 38:137.
[3] Melvin JP, Schrot RJ, Chu GM, et al. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery:a case series[J]. Can J Anaesth, 2018, 65(9):1057-65.
[4]Tulgar S, Kose HC, Selvi O, et al. Comparison of ultrasound-guided lumbar erector spinae plane block and transmuscular quadratus lumborum block for postoperative analgesia in hip and proximal femur surgery:a prospective randomized feasibility study[J]. Anesth Essays Res, 2018, 12(4):825-31.
[5] Pfeiffer G, Oppitz N, Schone S, et al. Analgesia of the axilla using a paravertebral catheter in the lamina technique[J]. Anaesthesist, 2006,55(4):423-7.
[6] Jüttner T, Werdehausen R, Hermanns H, et al. The paravertebral lamina technique:a new regional anesthesia approach for breast surgery[J]. J Clin Anesth, 2011, 23(6):443-50.
[7] Yoshida H, Yaguchi S, Matsumoto A, et al. A modified paravertebral block to reduce risk of mortality in a patient with multiple rib fractures[J]. Am J Emerg Med, 2015, 33(5):733-5.
[8] Ueshima H, Hara E, Otake H. Lumbar vertebra surgery performed with a bilateral retrolaminar block[J]. J Clin Anesth, 2017, 37:114.
[9] Nagane D, Ueshima H, Otake H. Upper lobectomy of the left lung using a left retrolaminar block[J]. J Clin Anesth, 2018, 49:74.
[10]Bianconi M, Ferraro L, Ricci R, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery[J]. Anesth Analg, 2004, 98(1):166-72.
[11]Mcgirt M J, Bydon M, Archer KR, et al. An analysis from the quality outcomes fatabase, part 1. disability, quality of life, and pain outcomes following lumbar spine surgery:predicting likely individual patient outcomes for shared decision-making[J]. J Neurosurg Spine, 2017, 27(4):357-69.
[12]Kim DK, Yoon SH, Kim JY, et al. Comparison of the effects of sufentanil and fentanyl intravenous patient controlled analgesia after lumbar fusion[J]. J Korean Neurosurg Soc, 2017, 60(1):54-9.
[13]Benyahia NM, Verster A, Saldien V, et al. Regional anaesthesia and postoperative analgesia techniques for spine surgery-a review[J].Rom J Anaesth Intensive Care, 2015, 22(1):25-33.
[14]Singh S, Chaudhary NK. Bilateral ultasound guided erector spinae plane block for postoperative pain management in lumbar spine surgery[J]. J Neurosurg Anesthesiol, 2019:1.
[15]Zeballos JL, Voscopoulos C, Kapottos M, et al. Ultrasound-guided retrolaminar paravertebral block[J]. Anaesthesia, 2013, 68(6):649-51.
[16]孙天胜,沈建雄,刘忠军,等.中国脊柱手术加速康复——围术期管理策略专家共识[J].中华骨与关节外科杂志, 2017, 10(4):271-9.
[17]Zhu Q, Li L, Yang Z, et al. Ultrasound guided continuous quadratus lumborum block hastened recovery in patients undergoing open liver resection:a randomized controlled, open-label trial[J]. BMC Anesthesiol, 2019, 19(1):23.
[18]Dang L, Chen Z, Liu X, et al. Lumbar disk herniation in children and adolescents:the significance of configurations of the lumbar spine[J]. Neurosurgery, 2015, 77(6):954-9.
[19]Stromqvist F, Stromqvist B, Jonsson B, et al. Surgical treatment of lumbar disc herniation in different ages-evaluation of 11,237 patients[J]. Spine J, 2017, 17(11):1577-85.
[20]Damjanovska M, Pintaric TS, Cvetko E, et al. The ultrasound-guided retrolaminar block:volume-dependent injectate distribution[J]. J Pain Res, 2018, 11:293-9.
[21]Sabouri AS, Crawford L, Bick SK, et al. Is a retrolaminar approach to the thoracic paravertebral space possible:a human cadaveric study[J]. Reg Anesth Pain Med, 2018, 1.
[22]Ueshima H, Hara E, Otake H. Lumbar vertebra surgery performed with a bilateral retrolaminar block[J]. J Clin Anesth, 2017, 37:114.
[23]Yang HM, Choi YJ, Kwon HJ, et al. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region:a cadaveric study[J].Anaesthesia, 2018, 73(10):1244-50.
[24]Murouchi T. Consideration of block nomenclature:erector spinae plane block or retrolaminar block[J]? Reg Anesth Pain Med, 2017, 42(1):124.
[25]Adhikary SD, Bernard S, Lopez H, et al. Erector spinae plane block versus retrolaminar block:a magnetic resonance imaging and anatomical study[J]. Reg Anesth Pain Med, 2018, 43(7):756-62.