Comparison Of Postoperative Analgesic Effects Of Ultrasound-guided Thoracolumbar Fascial Plane Block And Erector Spinal Plane Block In Posterior Lumbar Surgery

Objective:With the development of social economy and the progress of science and technology,the level of medical technology is also improving day by day.Ultrasonic visualization to make regional nerve block technique,this study mainly to observe and contrast ultrasound guided lumbar thoracic fascia plane block（thoracolumbar interfascial plane,TLIP）sma with vertical plane block（erector spinae plane,ESP）posterior lumbar surgery on postoperative analgesia effect and further the possible mechanism of this study was to evaluate the clinical application to provide new ideas and solutions.method:Prospective choose 90 cases in July 2019 to July 2020 in fuzhou city of jiangxi province in dongxiang district people’s hospital undergoing elective patients with lumbar fusion line after the middle of the road,using the random number table method the patients were randomly divided into three groups,respectively TLIP block joint vein self-control analgesia（patient controlled intravenous analgesia,PCIA）group（group T）,ESP block joint PCIA group（group E）and pure PCIA group（control group）,30 cases in each group.In group T,bilateral Tlip block was carried out under ultrasound guidance,and 0.33%ropivacaine 15ml was injected into the fascial space between bilateral longissimus pectoralis muscle and multifidus muscle,and sufentanil PCIA was given after surgery.In group E,bilateral ESP was blocked under ultrasound guidance,and 0.33%ropivacaine 15ml was injected into both sides of the lumbar segment in the groove formed by the root of the transverse process and the articular process,and sufentanil PCIA was given after surgery.The control group received only sufentanil PCIA after surgery without nerve block.All patients in the three groups received the following anesthesia induction regimens:intravenous midazolam 0.05mg/kg,sufentanil 0.5μg/kg,propofol 1.5-2mg/kg and atracurium cisbenesulfonate 0.15mg/kg.During the operation,propofol 4-8 mg/kg/h,remifentanil0.1-0.2μg/kg/min and cisatracurium 0.6-0.12 mg/kg/h were pumped continuously,and the Bispectral Index（BIS）was maintained at 40-60.The infusion speed was adjusted according to BIS and vital signs.General clinical data,including age,body mass index（BMI）and anesthesia ASA grade,were collected for both groups.Observe and record three groups of patients in the art of sufentanil and fentanyl dosage,three groups of patients with postoperative wake up of time,and postoperative 2 h（T₀）,postoperative 4 h（T₁）,6 h（T₂）after operation,postoperative（T₃）of 12 h and 24 h after surgery（T₄）pain visual analog scale（visual analogue scale,VAS）score and Ramsay sedation score,by ria method to detect T₀,T₁,T₂,T₃,and T₄epinephrine and norepinephrine levels,The number of PCIA compressions within 24 hours after operation and the incidence of adverse reactions within 24 hours after operation.result:Among the 90 patients who underwent posterior median approach lumbar fusion,30 cases were in control group,30 cases in T group,and 20 cases in E group.There were no significant differences in age,sex composition,body weight,anesthesia ASA grade and operation duration among the three groups（P>0.05）.There was no significant difference in intraoperative sufentanil dosage among the three groups（P>0.05）.Compared with the control group,intraoperative dosage of sufentanil was decreased in both group T and group E;Compared with T group,intraoperative dosage of sufentanil was increased in group E（P<0.05）.Compared with the control group,the recovery time of group T and group E was prolonged（P<0.05）.Compared with group T,the recovery time of group E was longer（P<0.05）.Compared with the control group,the number of remedial analgesia in group T and group E was decreased（P<0.05）.Compared with group T,the number of remedial analgesia in group E was decreased（P<0.05）.Compared with the control group,postoperative T0-T4VAS in group T and group E was significantly decreased（P<0.05）;Compared with group T,postoperative T0-T4VAS in group E was significantly decreased（P<0.05）.Compared with the control group,the contents of postoperative T0-T4E and NE in groups T and E were significantly decreased（P<0.05）;Compared with group T,postoperative T0-T4 E and NE in group E were significantly increased（P<0.05）.Compared with the control group,the number of PCIA compressions within24h after surgery in groups T and E decreased（P<0.05）.Compared with the T group,the number of PCIA compressions in group E within 24h after surgery increased（P<0.05）.Compared with the control group,the incidence of nausea and vomiting in group T and group E at 24h after surgery was decreased（P<0.05）.Compared with group T,the incidence of postoperative nausea and vomiting in group E was increased（P<0.05）.conclusion:Both desflurane and sevoflurane can be used in the operation of cleft lip and palate in children.However,compared with sevoflurane,desflurane can more effectively reduce the stress response,and the hemodynamics is more stable,and the recovery is more complete and rapid,safe and effective,which is worthy of clinical promotion and application.Both TLIP block and ESP block can be applied in midline approach lumbar fusion,which can not only reduce the amount of intraoperative opioids,improve recovery and improve effectiveness,but also reduce postoperative pain and relieve postoperative stress reaction.However,compared with ESP block,TLIP block has better effect and is worthy of clinical application.