摘要
目的观察超声引导下竖脊肌平面阻滞(erector spinae plane block,ESPB)对经皮椎间孔镜下髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)术中镇痛的效果。方法选择腰椎间盘突出症患者58例,按照随机数字表法分为ESPB组(试验组)和对照组。ESPB组(n=30)采用超声引导下竖脊肌平面阻滞麻醉,对照组(n=28)单纯应用关节突关节局部浸润麻醉。比较两组患者椎间孔成形期及纤维环操作期的疼痛数字评分(numerical rating scale,NRS);记录术中追加舒芬太尼患者人数、手术时间、住院时间等;比较术前及术后第6周Oswestry功能障碍指数(Oswestry disability index,ODI);比较两组患者的不良反应。结果ESPB组在椎间孔成形期的平均NRS评分及峰值NRS评分、纤维环操作期平均NRS评分均显著低于对照组(P<0.05)。对照组术中追加舒芬太尼人数显著多于ESPB组(P<0.05),两组手术时间、住院时间无显著差异(P>0.05)。两组患者术前及术后第6周ODI无显著差异(P>0.05)。两组均未出现呼吸抑制、一过性下肢感觉运动障碍情况。术中高血压、心动过速、术后恶心呕吐发生率,对照组显著高于ESPB组(P<0.05)。结论采用PELD治疗腰椎间盘突出症时,应用超声引导下竖脊肌平面阻滞麻醉可有效提高术中的镇痛效果,并降低不良反应的发生率。
Objective To observe the analgesic efficacy of ultrasound-guided erector spinae plane block(ESPB)in patients undergoing percutaneous endoscopic lumbar discectomy(PELD).Methods Fifty eight patients,41 males and 17 females,aged 18-70 years,falling into ASA physical statusⅠ-Ⅱ,scheduled for elective percutaneous endoscopic lumbar discectomy from september 2018 to September 2020 were enrolled and randomly divided into the ESPB group(experimental group)and the control group.For the ESPB group(n=30),patients received ultrasound-guided ESPB(n=28).For the control group,patients only received local anesthesia.The numerical rating scale(NRS)for pain evaluation was recorded at the time of lumbar foraminoplasty and annulus fibrosus operation.The number of additional sufentanil patients,operation time,hospital stay time,Oswestry disability index(ODI)at preoperation and 6 weeks after surgery and the adverse reactions of the two groups were compared.Results During lumbar foraminoplasty phase the peak NRS and average NRS of the ESPB group were significantly lower than those of the control group(P<0.05).During annulus fibrosus operation phase the average NRS of the ESPB group was significantly lower than that of the control group(P<0.05).The number of additional sufentanil in the control group was significantly higher than that in the ESPB group(P<0.05).There were no significant intergroup differences in the operation time,hospital stay time and oswestry disability index(ODI)at pre-operation and 6 weeks after surgery(P>0.05).There was no respiratory depression or transient lower limb sensorimotor disorder in the two groups(P>0.05).However,the incidences of intraoperative hypertension,tachycardia,postoperative nausea and vomiting in the control group were significantly higher than those in the ESPB group(P<0.05).Conclusion Ultrasound-guided erector spinae plane block can significantly improve the intraoperative analgesic efficacy and reduce the incidence of adverse reactions for the patients undergoing percutaneous endoscopic l
作者
阳婷婷
宋珂珂
汪博
王韶双
YANG Ting-ting;SONG Ke-ke;WANG Bo;WANG Shao-shuang(Department of Anesthesia and Surgery,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)
出处
《颈腰痛杂志》
2023年第4期578-581,共4页
The Journal of Cervicodynia and Lumbodynia
关键词
竖脊肌平面阻滞
经皮椎间孔镜下髓核摘除术
镇痛
腰椎间盘突出症
erector spinae plane block
percutaneous endoscopic lumbar discectomy
analgesic efficacy
lumbar disc herniation
