| Objectives To evaluate the clinical effect of the ultrasound-guided erector spinae plane block combined with general anesthesia in lumbar spinal surgery.Methods A total of 60 cases of selective patients(34 males and 26 females,ASA physical status I or II,age 45~65 years),with Lumbar internal fixation.The patients were randomly divided into 2 groups(n=30),the general anesthesia group(G group)and general anesthesia combined with erector spinal muscular block group(E group).In the E group,bilateral erector spinal muscle block was performed before the induction of general anesthesia,and 0.5% ropivacaine was 15 ml on each side.PCIA was used in all two groups at the end of the operation.After extubation,the E group measured the scope of the block of the vertical spinal muscle block.A recording time(T0),erector spinae Plane Block before operation(T1),instantly after skin incision(T2),15 min after the start of operation(T3),30 min after the start of operation(T4),at the end of operation(T5),extubation(T6),anesthesia recovery room immediately(T7),the anesthesia recovery room before(T8)mean arterial pressure(MAP),heart rate(HR),oxygen saturation(Sp O2),respiratory rate(RR),the total amount of propofol and remifentanil in operation,the total 48 h of sufentanil,range of extubation after erector spinae block,analgesia pump press the number of times,each time point after operation(2,6,12,24,48 h)and visual analogue score quiet activities(VAS),postoperative adverse reaction in 48 h of nausea and vomiting,lethargy,respiratory depression,pruritus incidence,postoperative hospitalization expenses and postoperative day.Results 1 The range of erector spinae plane block : After extubation,patients in group E measured the block of vertical spinal muscle block with acupuncture,18 cases were T12~L4 spinal nerve innervation area,and 12 cases were T12~L5 spinal nerve innervation area.2 Effect on MAP : There was no obvious fluctuation in the perioperative period of MAP in group G.In group E,MAP was significantly decreased at immediate(T2)and later time points in the surgical incision.There was a significant difference between the two groups(P<0.05).3 Effect on HR : There was no obvious fluctuation in the perioperative period of HR in group G.In group E,HR was significantly decreased at immediate(T2)and later time points in the surgical incision.There was a significant difference between the two groups(P<0.05).4 Effect on RR : There was no obvious fluctuation in the perioperative period of RR in the two groups,and there was no significant difference between the two groups in each time point observation group and between the 22 groups(P>0.05).5 Effect on Sp O2 : There was no significant difference in the difference between the two groups(P>0.05).6 Effect on VAS : The VAS scores of 2 h and 6 h were significantly lower in group E after operation(P<0.05).7 Effects on the dosage of drugs : The total amount of propofol and remifentanil in group E and the number of sufentanil and the pressure of analgesia pump were lower than that of group G at 48 hours.The two groups had statistical significance(P<0.05).8 Effects on adverse reactions : The incidence of nausea and vomiting in group E was lower than that in group G at 48 h after operation.There was a significant difference between the two groups(P<0.05).The incidence of drowsiness in 48 h group was not significantly higher than that in G group,and there was no statistical difference between the two groups(P>0.05).9 The impact of the postoperative hospital stay and the total cost of postoperative hospitalization : There was no significant difference between group E and group G after operation(P>0.05).Conclusions The erector spinae muscle block combined with general anesthesia can reduce peri operative anesthetic and analgesic dosage,reduce the incidence of adverse reactions caused by opioid,reduce the total hospitalization time and cost of patients,used in lumbar fixation is feasible and effective to large sample support to clinical application. |
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