竖脊肌平面阻滞联合氟比洛芬酯在微创经椎间孔腰椎融合术后镇痛效果观察

任博文; 韩振川; 刘庆祖; 吴剑慧; 刘建恒; 毛克亚

doi:10.3969/j.issn.2095-5227.2022.07.004

竖脊肌平面阻滞联合氟比洛芬酯在微创经椎间孔腰椎融合术后镇痛效果观察

Analgesic effect of erector spine plane block combined with flurbiprofen axetil in minimally invasive transforaminal lumbar fusion

摘要

摘要:
背景腰椎微创融合术后患者常出现中重度疼痛不适，因此术后疼痛控制尤为重要。竖脊肌平面阻滞技术(erector spinae plane block，ESPB)广泛应用于胸、腹、腰部手术镇痛。然而目前尚未有文献报道竖脊肌阻滞在微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF)术后的镇痛效果和安全性。
目的探讨竖脊肌平面阻滞用于MIS-TLIF术后镇痛效果及患者早期活动情况。
方法回顾性分析2020年10月- 2021年10月在解放军总医院第一医学中心行MIS-TLIF手术患者81例，A组为竖脊肌阻滞联合氟比洛芬酯静脉注射，男性9例，女性10例；B组为单纯氟比洛芬酯静脉注射，男性13例，女性17例；C组为静脉自控镇痛泵(patient controlled intravenous analgesia，PCIA)，男性14例，女性18例。比较三组患者术后(6 h、12 h、24 h、48 h、72 h)疼痛视觉模拟量表(visual analogue scale，VAS)评分、镇痛满意度、不良反应发生情况率、术后下地时间及排气时间。
结果三组年龄、性别、体质量指数、美国麻醉医师协会(American Society of Anesthesiologists，ASA)分级差异均无统计学意义(P＞0.05)。A组在术后6 h、12 h时VAS评分均低于B组和C组(P＜0.05)，在术后24 h、48 h时VAS评分低于B组，在72 h时三组VAS评分差异无统计学意义(P＞0.05)。A组术后镇痛满意度明显高于B组和C组(P＜0.05)，三组术后不良反应发生率差异无统计学意义(P＞0.05)。A组术后下地时间明显快于其余两组(P＜0.05)，术后排气时间较C组更快(P＜0.05)。
结论竖脊肌平面阻滞联合氟比洛芬镇痛为MIS-TLIF术后患者提供满意的镇痛效果，缩短了早期下地活动时间。

Abstract:
Background Patients often experience moderate to severe pain after minimally invasive lumbar spine fusion (MIS-TLIF), thus postoperative pain control is particularly important. The erector spinae plane block technique (ESPB) is widely used for analgesia in thoracic, abdominal and lumbar surgery. However, the analgesic effect and safety of ESPB after MIS-TLIF has not been reported in the literature.
Objective To investigate the analgesic effect and early activity of ESPB for postoperative analgesia after MIS-TLIF.
Methods From October 2020 to October 2021, 81 patients who underwent MIS-TLIF in Chinese PLA General Hospital were included, with 9 males and 10 females in group A for ESPB combined with flurbiprofen ester intravenously, 13 males and 17 females in group B for flurbiprofen ester alone intravenously, and 14 males and 18 females in group C for PCIA. The postoperative VAS scores (6 h, 12 h, 24 h, 48 h, 72 h), analgesic satisfaction, occurrence of adverse reactions and analgesic remedy, time of first leaving bed and first exhaust time were compared in the three groups.
Results There was no significant difference in age, sex, BMI, ASA classification between the three groups (all P>0.05). The VAS scores in group A were lower than those in group B and group C at 6 h and 12 h postoperatively (P<0.05), and lower than those in group B at 24 h and 48 h postoperatively, and there was no significant difference between the three groups at 72 h (P>0.05). Postoperative pain control satisfaction was significantly higher in group A than that in groups B and C (P<0.05), and there was no significant difference in the incidence of postoperative adverse events in the three groups (P>0.05). Postoperative time of first leaving bed was significantly faster in group A than in the remaining two groups (P<0.05), and postoperative time of first exhaustion was faster than in group C (P<0.05).
Conclusion ESPB combined with flurbiprofen axetil analgesia shows satisfactory analgesia effect and shortens the time to early activity in patients after MIS-TLIF.

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