Clinical Effect In Patients With Lumbar Disc Herniation Treated With Foraminoscopy During Ultrasound-guided ESPB

Lumbar disc hermiation is one kind of clinical common orthopaedic diseases,recent years the incidence of the disease presents an increasing trend and younger trend.The reason is mostly because of the surge in modern social life,working pressure,sedentary,and habits,lack of physical activity,which lead to the increasing incidence of the disease.At the present stage,surgical treatment is mainly used for patients with lumbar disc herniation.Surgical treatment can effectively relieve patients’pain,nerve compression and other symptoms,which is of great significance for improving patients’quality of life.With the gradual and widespread application of minimally invasive technology in clinical practice,foraminoscopy has become the main means of clinical treatment for patients with this disease.However,the requirements for anesthesia during surgery are relatively strict,which should not only take into account analgesia and keeping patients conscious,but also consider the less impact on patients’immune function and inflammatory factors.Traditional local infiltration anesthesia and intraspinal anesthesia are common anesthesia methods for foraminoscopy,However they can not take into account ideal analgesia and keep patients awake during surgery,and can stimulate the expression of inflammatory factors in patients after surgery,and induce severe surgical stress response.In recent years,erector Spinae plane block(ESPB)has been widely used in clinical thoracic surgery,which achieve rational analgesic effect and keep patients awake,and has a well adaptability in foraminoscopy.Based on this,this study conducted the effect of ESPB in percutaneous foraminoscopy and its effect on the expression of inflammatory factors in patients with lumbar disc hermiation.Objective:The purpose of this study was to investigate the analgesic effects of ultrasound-guided percutaneous lateral/posterior foraminal lumbar discectomy under erector spinal plane block compared with local infiltration anesthesia under percutaneous lateral/posterior foraminal lumbar discectomy and its influence on patients’immune function,so as to provide reference for intraoperative and postoperative pain management and immune function protection in clinical patients with lumbar disc herniation.This study provides a new analgesic mode and broadens the application scope of ESPB under ultrasound guidance,which has certain clinical significance.Methods:Fifty-four patients with lumbar disc herniation were enrolled in the Department of Pain,Xi’an Third Hospital from January 2020 to October 2021,who were fit for the indication of foraminal endoscopic discectomy were selected.The subjects were divided into control group and experimental group by random number table method,27patients in each group.In the experimental group,ultrason-guided ESPB was injected with 0.375%ropivacaine and 0.5%lidocaine(20ml).The control group received conventional local infiltration anesthesia,local lidocaine plus ropivacaine was used,local infiltration anesthesia 0.375%ropivacaine and 0.5%lidocaine was 20ml.Sufentanil was used for analgesia in patients with intolerance in both groups.Clinical arrest,Ramsay sedate score,intraoperative blood pressure(MAP),heart rate(HR),postoperative VAS score,proportion of CD4~+T and CD8~+T lymphocytes in peripheral blood,IL-6,TNF-αand IFN-γlevels in serum,incidence of postoperative adverse reactions,length of postoperative hospital stay and hospitalization cost of patients in 2groups were compared and analyzed.Results:1.A total of 54 subjects were included in this study,which were randomly divided into control group and experimental group,with 27 cases in each group.There were no significant differences in age,gender,Body Mass Index(BMI),ASA grade,surgical site and surgical approach between 2 groups(P>0.05).2.The onset time of block in experimental group was significantly shorter than that in control group,and the difference was statistically significant(P<0.05).There was no significant difference in the duration of block between 2 groups(P>0.05).The number of block planes in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).3.Ramsay scores of the two groups showed a decreasing trend at 2h,6h and 8h after surgery.Ramsay sedation assessment showed no significant difference between groups at 2h and 6h after surgery(P>0.05).Ramsay score of the experimental group was significantly higher than that of the control group at 8h after surgery,and the difference was statistically significant(P<0.05).4.There was no significant difference in MAP level between 2 groups at T0 and T3(P>0.05).Compared with T0,MAP level of the two groups was significantly increased at T1 and T2,and the experimental group was significantly lower than the control group,with statistical significance(P<0.05).5.There was no significant difference in HR level between 2 groups at T0 time point(P>0.05).At T1,T2 and T3,HR level in 2 groups was significantly increased compared with T0,and the experimental group was significantly lower than the control group,with statistical significance(P<0.05).6.VAS scores of patients in the experimental group were significantly lower than those in the control group at 12,24 and 48h after surgery,with statistical significance(P<0.05).7.The proportion of CD4~+T cells in peripheral blood of the experimental group was significantly higher than that of the control group,and the level of CD8~+T cells was significantly lower than that of the control group at 24h and 48h after surgery,with statistical significance(P<0.05).8.Serum levels of IL-6 and TNF-αlevels in the experimental group were significantly lower than those in the control group,and the levels of IFN-γlevels were significantly higher than those in the control group 24h and 48h after surgery,with statistical significance(P<0.05).9.After operation,the incidence of adverse reactions in the experimental group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).10.The postoperative hospitalization time of patients in the experimental group was significantly shorter than that in the control group,and the postoperative hospitalization cost was significantly lower than that in the control group,with statistical significance(P<0.05).Conclusion:1.Ultrasound-guided spinal plane block can provide ideal intraoperative and postoperative analgesia effect for patients with lumbar disc herniation undergoing foraminoscopy.Physiological indicators such as blood pressure and heart rate of patients are stable during surgery,and postoperative pain is low.2.Ultrasound-guided spinal plane block can regulate the proportion of CD4~+/CD8~+T lymphocytes and reduce the level of inflammatory cytokines in patients with lumbar disc herniation,and the postoperative recovery period of patients is shorter,which has high clinical application value.