超声引导下竖脊肌平面阻滞和椎板后阻滞联合全身麻醉用于脊椎手术的比较
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摘要
目的观察和对比超声引导下竖脊肌平面阻滞(ESPB)和椎板后阻滞(RLB)在后入路脊椎手术中的应用效果。方法选择2017年5月至2018年1月择期行后入路脊椎手术的患者60例,男35例,女25例,年龄45～65岁,BMI 18～32 kg/m~2,ASAⅠ或Ⅱ级。随机分为超声引导下双侧ESPB组(ESPB组)、超声引导下双侧RLB组(RLB组)和对照组(C组),每组20例。手术开始前,取俯卧位,ESPB组和RLB组均采用旁矢状位平面内法超声引导,ESPB组引导穿刺针至横突后表面,RLB组引导穿刺针至椎板后表面,每侧注入0.4%的罗哌卡因20 ml。C组不予阻滞,三组均予全身麻醉。记录三组术中舒芬太尼、瑞芬太尼和顺式阿曲库铵的用量、尿量、出血量和气管导管拔管时间。记录三组术后4、12、24、48 h VAS评分;记录ESPB组和RLB组患者术后48 h内穿刺部位疼痛,肿胀和感染等不良反应发生情况。结果 ESPB组和RLB组舒芬太尼用量、瑞芬太尼用量和顺式阿曲库铵用量明显低于C组(P<0.05)。三组术中尿量、出血量和气管导管拔管时间差异无统计学意义。术后4、12、24、48 h ESPB组和RLB组VAS评分明显低于C组(P<0.01),ESPB组和RLB组术后48 h内均未发生穿刺部位疼痛、肿胀和感染等不良反应。结论超声引导下双侧ESPB和RLB联合全身麻醉均能够减少后入路脊椎手术中阿片类药物和肌松药用量,不影响术中尿量、出血量和气管导管拔管时间,并能够提供良好的术后镇痛效果。
Objective To compare the clinical effects of ultrasound-guided erector spinae plane block(ESPB) and retrolaminal block(RLB) during posterior approach vertebral surgery. Methods Sixty patients, 35 males and 25 females, aged 45-65 years, BMI 18-32 kg/m~2, ASA physical status Ⅰ or Ⅱ, scheduled for elective posterior approach vertebral surgery from May 2017 to January 2018, were included and randomly divided into three groups(n = 20): group ESPB, group RLB and control group(group C). Both of the two trial groups were ultrasound-guided using parasagittal in-plane method before surgery in prone position except for group C. General anesthesia was applied in all three groups. 20 ml of 0.4% ropivacaine was injected into the posterior surface of transverse process in group ESPB or the posterior surface of laminar in group RLB. Sufentanil, remifentanil and cisatracurium consumption, urine volume, blood loss, extubation time and VAS score at 4, 12, 24, 48 h after operation were recorded. The adverse reactions such as pain, swelling and infection were recorded within 48 hours after operation in group ESPB and group RLB.Results Comparing with group C, both of the group ESPB and group RLB had a significant decrease in sufentanil, remifentanil, and cisatracurium consumption(P < 0.05), a similar urine volume and blood loss, a similar extubation time, and a prominent reduced VAS score at 4, 12, 24, 48 h after operation(P < 0.01). No pain, swelling or infection of the puncture site occurred within 48 hours after surgery in any of the two block groups. Conclusion Both ultrasound-guided bilateral ESPB and RLB combined with general anesthesia significantly decrease the opioid consumption and muscle relaxant consumption without impact on urine volume, blood loss and extubation time during posterior approach vertebral surgery, and provide satisfactory postoperative analgesia.
Objective To compare the clinical effects of ultrasound-guided erector spinae plane block(ESPB) and retrolaminal block(RLB) during posterior approach vertebral surgery. Methods Sixty patients, 35 males and 25 females, aged 45-65 years, BMI 18-32 kg/m~2, ASA physical status Ⅰ or Ⅱ, scheduled for elective posterior approach vertebral surgery from May 2017 to January 2018, were included and randomly divided into three groups(n = 20): group ESPB, group RLB and control group(group C). Both of the two trial groups were ultrasound-guided using parasagittal in-plane method before surgery in prone position except for group C. General anesthesia was applied in all three groups. 20 ml of 0.4% ropivacaine was injected into the posterior surface of transverse process in group ESPB or the posterior surface of laminar in group RLB. Sufentanil, remifentanil and cisatracurium consumption, urine volume, blood loss, extubation time and VAS score at 4, 12, 24, 48 h after operation were recorded. The adverse reactions such as pain, swelling and infection were recorded within 48 hours after operation in group ESPB and group RLB.Results Comparing with group C, both of the group ESPB and group RLB had a significant decrease in sufentanil, remifentanil, and cisatracurium consumption(P < 0.05), a similar urine volume and blood loss, a similar extubation time, and a prominent reduced VAS score at 4, 12, 24, 48 h after operation(P < 0.01). No pain, swelling or infection of the puncture site occurred within 48 hours after surgery in any of the two block groups. Conclusion Both ultrasound-guided bilateral ESPB and RLB combined with general anesthesia significantly decrease the opioid consumption and muscle relaxant consumption without impact on urine volume, blood loss and extubation time during posterior approach vertebral surgery, and provide satisfactory postoperative analgesia.
引文
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[9] 刘天柱,花璐,万里.竖脊肌平面阻滞用于腰椎切口清创术一例.临床麻醉学杂志,2018,34(9):933-934.
[10] Tulgar S,Kapakli MS,Senturk O,et al.Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy:a prospective,randomized,controlled clinical trial.J Clin Anesth,2018,49:101-106.
[11] 马丹旭,任惠龙,芮燕,等.超声引导下单次竖脊肌平面阻滞对胸腔镜下肺叶切除患者静脉自控镇痛效果的影响.临床麻醉学杂志,2017,33(10):965-967.
[12] Tsui BCH,Mohler D,Caruso TJ,et al.Cervical erector spinae plane block catheter using a thoracic approach:an alternative to brachial plexus blockade for forequarter amputation.Can J Anaesth,2019,66(1):119-120.
[13] Nagane D,Ueshima H,Otake H.Upper lobectomy of the left lung using a left retrolaminar block.J Clin Anesth,2018,49:74.
[14] Murouchi T,Yamakage M.Retrolaminar block:analgesic efficacy and safety evaluation.J Anesth,2016,30(6):1003-1007.
[15] Yoshida H,Yaguchi S,Chiba N,et al.Ultrasound-guided lumbar retrolaminar block for acute lumbar trauma.Anaesth Intensive Care,2015,43(4):528-529.
[16] Ivanusic J,Konishi Y,Barrington MJ.A cadaveric study investigating the mechanism of action of erector spinae blockade.Reg Anesth Pain Med,2018,43(6):567-571.
[17] Damjanovska M,Stopar Pintaric T,Cvetko E,et al.The ultrasound-guided retrolaminar block:volume-dependent injectate distribution.J Pain Res,2018,11:293-299.
[18] Chin KJ,Malhas L,Perlas A.The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery:a report of 3 cases.Reg Anesth Pain Med,2017,42(3):372-376.
[2] Hand WR,Taylor JM,Harvey NR,et al.Thoracolumbar interfascial plane (TLIP) block:a pilot study in volunteers.Can J Anaesth,2015,62(11):1196-1200.
[3] Ueshima H,Otake H.Similarities between the retrolaminar and erector spinae plane blocks.Reg Anesth Pain Med,2017,42(1):123-124.
[4] Al-Alami A,Abou El Ezz A,Kassab F.Ultrasound guided dorsal ramus nerve block for reduction of postoperative pain in patients undergoing lumbar spine surgery:a case series imaging study.Middle East J Anaesthesiol,2015,23(2):251-256.
[5] Murouchi T.Consideration of block nomenclature:erector spinae plane block or retrolaminar block?Reg Anesth Pain Med,2017,42(1):124.
[6] Voscopoulos C,Palaniappan D,Zeballos J,et al.The ultrasound-guided retrolaminar block.Can J Anaesth,2013,60(9):888-895.
[7] Adhikary SD,Bernard S,Lopez H,et al.Erector spinae plane block versus retrolaminar block:a magnetic resonance imaging and anatomical study.Reg Anesth Pain Med,2018,43(7):756-762.
[8] Chung K,Kim ED.Continuous erector spinae plane block at the lower lumbar level in a lower extremity complex regional pain syndrome patient.J Clin Anesth,2018,48:30-31.
[9] 刘天柱,花璐,万里.竖脊肌平面阻滞用于腰椎切口清创术一例.临床麻醉学杂志,2018,34(9):933-934.
[10] Tulgar S,Kapakli MS,Senturk O,et al.Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy:a prospective,randomized,controlled clinical trial.J Clin Anesth,2018,49:101-106.
[11] 马丹旭,任惠龙,芮燕,等.超声引导下单次竖脊肌平面阻滞对胸腔镜下肺叶切除患者静脉自控镇痛效果的影响.临床麻醉学杂志,2017,33(10):965-967.
[12] Tsui BCH,Mohler D,Caruso TJ,et al.Cervical erector spinae plane block catheter using a thoracic approach:an alternative to brachial plexus blockade for forequarter amputation.Can J Anaesth,2019,66(1):119-120.
[13] Nagane D,Ueshima H,Otake H.Upper lobectomy of the left lung using a left retrolaminar block.J Clin Anesth,2018,49:74.
[14] Murouchi T,Yamakage M.Retrolaminar block:analgesic efficacy and safety evaluation.J Anesth,2016,30(6):1003-1007.
[15] Yoshida H,Yaguchi S,Chiba N,et al.Ultrasound-guided lumbar retrolaminar block for acute lumbar trauma.Anaesth Intensive Care,2015,43(4):528-529.
[16] Ivanusic J,Konishi Y,Barrington MJ.A cadaveric study investigating the mechanism of action of erector spinae blockade.Reg Anesth Pain Med,2018,43(6):567-571.
[17] Damjanovska M,Stopar Pintaric T,Cvetko E,et al.The ultrasound-guided retrolaminar block:volume-dependent injectate distribution.J Pain Res,2018,11:293-299.
[18] Chin KJ,Malhas L,Perlas A.The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery:a report of 3 cases.Reg Anesth Pain Med,2017,42(3):372-376.