Effect Of Ultrasound-guided Continuous Erector Spinal Plane Block On Analgesia And Early Rehabilitation Of Patients Undergoing Selective Open Hepatectomy For Hepatic Carcinoma

Objective:To observe and evaluate the effect of ultrasound-guided unilateral continuous erector spinal plane block（ESPB）on the analgesia and early rehabilitation of patients undergoing open hepatectomy for hepatic carcinoma.Methods:A total of 100 patients undergoing open hepatectomy for hepatic carcinoma during October 2019 and October 2020 were selected and divided into the ESPB group（n=50）and the patient-controlled intravenous analgesia（PCIA）group（n=50）randomly.The patients in ESPB group accepted continuous ESPB on the right side before induction of anesthesia and the extent of cutaneous sensory block after 1 hour of block was measured.The patients in the PCIA group did not receive any nerve block.Both groups received general anesthesia with endotracheal intubation and uniform intraoperative anesthesia management.Postoperative ESPB group was given intermittent pulse timing pump for analgesia,and PCIA group was connected with electronic analgesia pump through vein.The postoperative visual analogue score,intraoperative total dosage of opioids and vital signs were observed and recorded in two groups.The dosage of additional intravenous analgesics after operation,the recovery rate of additional analgesics,the first press time of analgesic pump,the first activity out of bed and anal exhaust time,the length of hospital stay,the patient satisfaction score and complications were recorded and analyzed in two groups.The range of cutaneous sensory block in ESPB group and the diffusion of local anesthetics in volunteers under MRI after a single ESPB were observed.Results:1.There was no significant difference in age,height,body weight,BMI and the time of operation time between the two groups（P>0.05）.2.Compared with PCIA group,ESPB group had lower VAS scores at rest and activity at 6 h,12 h,24 h and 48 h after surgery（P<0.05）.3.The total consumption of opioids in ESPB group was significantly decreased（P<0.05）;In addition,the dosage of additional intravenous flurbiprofenester and the recovery rate of additional analgesics were significantly decreased in ESPB group,and the first pressure time of PCIA was significantly prolonged（P<0.05）.4.The variability of MAP,HR in ESPB groups was significantly decreased at time of immediately after incision（T₃）,1 min after abdominal exploration（T₄）,immediately after liver incision（T₅）,5 min after skin suture（T₆）,and 15 min after extubation（T₇）.Besides,the intraoperative blood loss was significantly decreased,and the norepinephrine and crystalloid requirement was less（P<0.05）;The fluctuation of postoperative blood glucose（T₂）in ESPB group was significantly reduced（P<0.05）.5.Compared with PCIA group,the incidence of PONV in ESPB group was lower（P<0.05）,but there was no significant difference in the incidence of respiratory depression,hypotension and pruritus（P>0.05）.6.Compared with PCIA group,values of the first time of out-of-bed and the first exhaust time in ESPB group,hospitalization time was lower than PCIA group,with a higher satisfaction of patients（P<0.05）.7.The cutaneous sensory block area was limited to the right posterior thoracic back,but not beyond the right posterior axillary line.MRI performed 1h after ESPB showed that most local anesthetics diffused to the posterior erector spinal muscle,the paravertebral muscle and a small part of local anesthetic solution diffused along the direction of intervertebral foramen;The local anesthetic solution diffused along the thoracolumbar fascia in the direction of head and tail to the cutaneous sensory block at the level of T1～L1.Conclusion:Ultrasound-guided continuous unilateral erector spinal block has a significant analgesic effect on postoperative analgesia of liver cancer after laparotomy,reducing adverse reactions,promoting rapid recovery of patients after operation,shorting the length of hospital stay and improving patient satisfaction.