Effect Of Esketamine Combined With Ropivacaine In Retrolaminar Block On Postoperative Analgesia In Patients With Lumbar Spinal Fusion Surgery

Objective:To evaluate the effect of ultrasound-guided retrolaminar block of esketamine combined with ropivacaine on postoperative analgesia in patients with lumbar spinal fusion surgery.Methods:Fifty-eight patients,aged 18-65 years,American Society of Anesthesiologists（ASA）grade I-III,scheduled for lumbar spinal fusion surgery,were randomly divided into 2 groups,with 29 patients in each group.All patients received ultrasound-guided retrolaminar block.The control group（group R）was given 20m L0.375%ropivacaine on each side,and the experimental group（group E）was given20m L 0.375%ropivacaine and esketamine（0.15mg/kg）on each side.General anesthesia was performed after the block took effect.Patients in both groups were treated with intravenous analgesia pump:sufentanil 150μg and normal saline 150 m L,setting background infusion 2m L/h,a single press 2m L/time,lockout time 15min.The time of first pressing analgesic pump within 48h after operation,the number of effective pressing analgesic pump within 48h and the number of rescue analgesia were recorded.Mean arterial pressure（MAP）and heart rate（HR）were recorded at admission（T₀）,10min after block（T₁）,20min after block（T₂）,after induction of anesthesia（T₃）,skin incision（T₄）,extubation at the end of operation（T₅）.Visual analogue scale（VAS）scores were recorded at 1h（T₆）,2h（T₇）,4h（T₈）,8h（T₉）,12h(T₁₀),24h(T₁₁),48h(T₁₂)after operation in resting state and movement state.The consumption of propofol and remifentanil during operation and sufentanil within 48h after operation were recorded.The sleep quality and patient satisfaction with analgesia on the day after operation were recorded.The complications related to nerve block,adverse reactions,and postoperative hospital stay were observed and recorded.Results:Compared with group R,the time of first pressing analgesic pump was significantly prolonged and the number of effective pressing analgesic pump was significantly reduced in group E within 48 hours after operation（P<0.05）.Compared with R group,static VAS score of T₇-T₁₀and dynamic VAS score of T₇-T₁₁in group E were significantly decreased（P<0.05）;Compared with R group,the consumption of remifentanil and sufentanil 48h after surgery in group E was reduced（P<0.05）,while the consumption of propofol was not statistically significant（P>0.05）.Compared with R group,sleep quality and satisfaction with analgesia in group E on the day after surgery were significantly improved,with statistical significance（P<0.05）.Compared with R group,there were no significant differences in the number of patients in group E for relief analgesia and postoperative hospital stay（P>0.05）.Compared with R group,there was no significant difference in MAP and HR in group E（P>0.05）.There was no significant difference in the incidence of postoperative complications between the two groups（P>0.05）.Conclusion:The ultrasound-guided esketamine combined with ropivacaine for retrolaminar block can significantly prolong the duration of nerve block analgesia,effectively reduce perioperative analgesic drug consumption,and does not increase the incidence of complications.It provides effective analgesia for patients undergoing lumbar spinal fusion surgery and promotes rapid recovery of patients.