Ultrasound-guided Erector Spinae Plane Block(ESPB)for The Treatment Of Acute Gastrointestinal Injury(AGI)

BackgroundAcute gastrointestinal injury is one of the common complications of ICU patients.Its clinical manifestations are gastric retention,Feeding intolerance syndrome(FI),intra-abdominal hypertension(IAH)and so on.Estimated the global incidence of acute gastrointestinal injury in critically ill patients is 40%(27%-54%),while the domestic incidence is about 86.18%.Although there are many treatments for acute gastrointestinal injury,such as prokinetic drugs,traditional Chinese medicine,acupuncture,etc.The therapy on AGI is still difficult.Up to now,there is only one clinical study on nerve block in the treatment of acute gastrointestinal injury,which shows that celiac nerve block can improve acute gastrointestinal injury.In recent years,ultrasound-guided Erector spinae plane block(ESPB),as a new way of interfascial nerve block,has become more and more popular because of its higher security and less complications.However,there is no study on the application of Erector spinae plane block(ESPB)in the treatment of acute gastrointestinal injury.Therefore,in this study,ICU patients with acute gastrointestinal injury were treated with Erector spinae plane block(ESPB)on the basis of routine treatment,and the safety and efficacy of ESPB in the treatment of AGI were evaluated.Objective1.To investigate the effect of ultrasound-guided Erector spinae plane block(ESPB)on the mitigation and prognosis of ICU patients with acute gastrointestinal injury(AGI).2.To evaluate the effect of ultrasound-guided Erector spinae plane block(ESPB)on AGI grade,inflammatory factor level,intraperitoneal pressure,gastric residual volume and cross-sectional area of gastric transverse antrum in ICU patients.MethodsA clinical randomized controlled trial was conducted in ICU of Zhujiang Hospital of Southern Medical University.A total of 42 patients with acute gastrointestinal injury treated in ICU of Hospital from September 2019 to February 2020 were randomly divided into two groups.The ICU patients in the control group were given routine clinical treatment.While,on the basis of same routine treatment,the intervention group received ultrasound-guided Erector spinae plane block(ESPB)and continuous catheterization in the bilateral 8th thoracic vertebra(T8),and then twice a day,was bilaterally injected with 20ml 0.375%ropivacaine for one week.We set 6 different observation points at the time of beginning and 1st,2nd,3rd and 7th days after admission into group.The AGI grade,the level of inflammatory factors,intra-abdominal pressure,Gastric residual volume and cross-sectional area of gastric antrum under ultrasound were recorded in all patients.The outcomes measures included the cure rate,remission rate and 28-day mortality rate of AGI.ResultsAccording to the standard of admission and excretion,in total of 42 patients were included,including of 20 patients in the intervention group and 22 patients in the control group.The results showed that in the intervention group,the AGI grade on the 7th day was lower than that of the AGI grade at the beginning,and the difference was statistically significant(P<0.05).In the control group,there was no difference between the AGI grade on the 7th day and the AGI grade at the beginning.On the 7th day,the remission rate of AGI in the control group was 20.0%,and the cure rate was 5.0%.While the remission rate of AGI in the intervention group was 54.5%,and the cure rate was 22.1%.There were 4 cases of aggravation of AGI in the control group,but none in the intervention group.During follow-up 28 days after joining the group,there were 13 deaths(65.00%)in the control group and 5 deaths(22.73%)in the intervention group.There was no statistically significant difference in inflammation index,GIF score,SOFA score,length of stay in ICU,total hospitalization time and cost between the two groups(P>0.05).There was no statistical difference in gastric residual volume,intra-abdominal pressure and cross-sectional area of gastric antrum between the two groups(P>0.05).Compared with the nasal feeding pump speed at the time of entering the group,there was a statistical difference in the nasal feeding pump speed on the 3rd day in the intervention group(P<0.05),but it can't be found in the control group.There were only 3 cases of adverse events related to ultrasound-guided erector spinae plane block(ESPB)treatment,including 1 case of tube removal and 2 cases of blood oozing at the puncture site.In the follow-up observation,the wound of puncture site had healed well without complications.No serious adverse events occurred.Conclusion:1.Erector spinae plane block(ESPB)is safe and effective on AGI.On the basis of routine treatment,ultrasound-guided erector spinae plane block(ESPB)can increase the cure rate of AGI patients.However,ultrasound-guided vertical spinal muscle plane block(ESPB)can not reduce the length of stay in ICU,total hospital stay and costs of ICU patients with AGI.2.The sample size of this study is relatively small,and the conclusion still needs to be further confirmed by a large sample clinical study.