Ultrasound Guided Erector Spine Block As An Adjuvant To General Anesthesia And Postoperative Analgesia In Patients Undergoing Lumbar Spine Surgery

Objectives:To research the clinical application of ultrasound-guided Erector spinae plane(ESP)block in posterior lumbar spine surgery.To observe the effect of single patient-controlled intravenous analgesia(PCIA)and preoperative ESP block combined with PCIA on postoperative analgesia in patients,and evaluate the safety and efficacy of ESP block combined with PCIA for postoperative pain management in patients with lumbar posterior surgery.Methods:Sixty patients(29 males and 31 females,aged 18-70 years,BMI20-27kg/m~2,ASA I or II)undergoing two intraoperative lumbar vertebrae with general anesthesia were enrolled in this study.They were divided into two groups by using the random number table method,including ESP block combined with PCIA group(EP group)and PCIA group(P group).Patients in the EP group received ultrasound-guided erector spinae plane block in prone position before general anesthesia with 15ml 0.5%ropivacaine hydrochloride at each side while the patients in P group received only general anesthesia.All patients received PCIA after operations.Mean arterial pressure(MAP)and heart rate(HR)were measured at ten min before anesthesia induction,ten min before incision,cutting the skin,immediate decompression of the spinal canal,right after the surgery completed.Cut and calculate the two groups of patients with ten minutes before skin incision and cutting the skin of the difference of mean arterial pressure and heart rate?MAP and?HR;the frequency of unstable hemodynamics,dosage of opioid and muscle relaxant,satisfaction of the surgeon with muscle relaxation,and operation time were recorded.Postoperative VAS scores at 1,6,12,24,48 h,the frequency of PCIA compressions,patient satisfaction with postoperative analgesia,rescue analgesic administrations,the length of hospital stay,the first out-of-bed activity time,time to first flatus,and postoperative complications(e.g.nausea and vomiting,itchy skin,urinary retention,postoperative incision infection at48 hours after surgery)were recorded as well.Results:There were no statistical differences between the two groups in gender,age,body mass index,ASA classification,operation time,intraoperative fluid volume and disease types.There was no significant fluctuation in the perioperative MAP and HR in EP group,but significant fluctuation in the MAP and HR at the time point of skin cutting and later in P group(P<0.05).The difference between?MAP and?HR of MAP and HR in the EP group compared with the P group was less than that in the P group(P<0.05).The number of intraoperative hemodynamic instability in EP group was less than that in P group,and intraoperative vital signs were more stable(P<0.05).Compared with the P group,in EP group the maintenance dosage of remifentanil and cis-atracurium were lower than P group,the total amount of cis-atracurium were lower as well(P<0.05).The surgeon's satisfaction with the muscle relaxation of the EP group was significantly improved(P<0.05).And the satisfaction of postoperative analgesia was significantly improved in the EP group(P<0.05).Postoperative VAS scores at rest state in the EP group were significantly lower than the P group at the 1h,6h and 12h(P<0.01),while it was dramatically lower than P group when turning over on the bed at the1h,6h,12h,24h and 48 h(P<0.05).The frequency of PCIA compressions and the administration of parecoxib sodium in EP group were notably less than P group(P<0.05).The time of postoperative activity and flatus in EP group were earlier than that in P group,and the duration of hospital stay in EP group was less than P group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions such as drowsiness,nausea,vomiting,respiratory depression,urinary retention,pruritus and postoperative incision infection between the two groups within 48 h after surgery(P>0.05).Conclusion:General anesthesia combined with ultrasound-guided erector spinae block can keep vital signs stable in lumbar posterior surgery,reduce the dosage of intramuscular relaxants and opiates,and effectively relieve postoperative pain.It also can be benefit for earlier activity after surgery and reduce hospital stay.The ESP block combined with PCIA is a safe and effective postoperative pain management model in patients with posterior lumbar surgery.