| Objective To investigate the efficacy and safety of ultrasound-guided erector spinae plane block(ESP)in postoperative analgesia after laparoscopic nephrectomy.Methods This study has been approved by the ethics committee of the general hospital of Ningxia Medical University(ethics number:2019-469).In this study,60 patients were selected for the first time under total intravenous anesthesia(TIVA)elective laparoscopic nephrectomy(LN),aged 20-60 years,regardless of gender;ASA(American Society of Anesthesiologists)grade?-?;body mass index(Body Mass Index,BMI)18.5-28kg/m~2.According to the random number table method,patients were divided into three groups:the patient-controlled intravenous analgesia(PCIA)group(group P),and the erector spinae plane block(ESPB)group(group E),And ESPB combined with PCIA group(EP group).Patients in group E and EP were treated with ultrasound-guided single erector spinae block before endotracheal intubation after the operation was completed.The drug used was 0.5%ropivacaine 30ml.Patients in group P and EP were connected with an analgesic pump after the operation.The analgesic pump configuration method was sufentanil 1.5ug/kg diluted to 100ml,the first dose was 5ug,the background infusion dose was 2ml/h,and the controlled additional dose was 0.5ml,lock time 15min.All patients with postoperative VAS score greater than 4 were treated with diclofenac sodium lidocaine injection for analgesia.The VAS scores of 30min,1h,4h,8h,12h,and 24h resting and coughing states were recorded respectively;the analgesic rate and the number of effective analgesic pump compressions within 24 hours after surgery were recorded.Observe the incidence of postoperative adverse reactions such as nausea,vomiting,and skin pruritus,and assess whether patients undergoing ESPB develop neuroblock complications such as local anesthetic poisoning,pneumothorax,subcutaneous hematoma,and total spinal anesthesia.Results Compared with group P,the VAS scores of patients in EP group at different time points and the scores of resting and coughing states of patients in group E at30 min,1 h,4 h,and 8 h after operation were lower than those in group P(P<0.05),but postoperatively At 12h and 24h,the VAS score of E group was higher than that of P group(P<0.05).Compared with the E group,the EP group had significantly lower VAS scores at different time points after operation(P<0.05).The postoperative relief analgesia rate in EP group was lower than that in P group and E group,the difference was statistically significant(P<0.05);the difference between P group and E group was not statistically significant(P>0.05).The number of postoperative analgesic pumps in the EP group was lower than that in the P group,and the difference was statistically significant(P<0.05).The incidences of postoperative nausea,vomiting,and skin pruritus in group E and EP were lower than those in group P(P<0.05);the incidence of postoperative nausea,vomiting,and skin pruritus in group EP were higher than those in group E(P<0.05).None of the patients undergoing ESPB experienced local anesthetic poisoning,subcutaneous hematoma,pneumothorax,and total spinal anesthesia.Conclusion Ultrasound-guided erector spiane plane block can be safely and effectively applied to patients undergoing laparoscopic nephrectomy and can be used as a new type of postoperative analgesia. |
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