| Objective:This paper observed the effects of ultrasound – guided bilateral erector spinae plane block on analgesia and immune function in posterior lumbar surgery in elderly patients.Methods:There were 60 cases of lumbar spine surgery under general anesthesia from June to October 2019 in Ganzhou people’s hospital.The cases were randomly divided into two groups,general anesthesia combined ESPB group(group A)and control group(group B),30 patients in each group.In group A,bilateral plane block of erector spinal muscle was performed under ultrasound guidance before anesthesia induction,and 0.375% ropivacaine 20 ml was injected on each side;routine anesthesia was induced in group B,and postoperative controlled intravenous analgesia(PCIA)was performed in both groups.The intraoperative maintenance amounts of propofol,remifentanil and cisatracurium in the two groups were recorded.Meanwhile,we recorded the recovery time of PACU,irritability and other complications during the recovery period.VAS score,mean arterial pressure(MAP)and SPO2 were compared between the two groups at 1,2,6,12,24 and 48 h after surgery.We recorded the times of pressing the analgesic pump,analgesic relief times,patient satisfaction and adverse reactions of the two groups 48 h after surgery.The levels of CD4+%,CD8+%andγinterferon were compared between the two groups before surgery(T0),immediately after surgery(T1),4 hours after surgery(T2),12 hours after surgery(T3)and 24 hours after surgery(T4).CD4+% and CD8+% were measured by flow cytometry,and the interferon-γ was measured by enzyme-linked immunosorbent assay.Results:1.There is no significant difference in age,gender,BMI,basic patient history,ASA classification of the patients.There is no statistical significance of the operation time between two groups.2.Compared to group B,the intraoperative maintenance dosage of propofol,remifentanil and cisatracurium in group A was significantly lower than that in group B(P < 0.05).The recovery time of PACU,irritability and other complications in group A were lower than those in group B(P < 0.05).VAS scores of patients in group A at 1,2,6,12 and 24 h after surgery were significantly lower than those in group B(P < 0.05).The number of pressing the analgesic pump within 48 hours after surgery was significantly lower in group A than in group B(P < 0.05).The satisfaction of patients in group A was significantly higher than that in group B.One patient in group A had skin redness and swelling after surgery,one patient in group B had respiratory depression,and six patients had nausea and vomiting.3.There is no significant difference in CD4+%,CD8+% andγinterferon levels before surgery between two groups(P > 0.05).Immediately after surgery,4 hours after surgery,12 hours after surgery,and 24 hours after surgery,CD4+%,CD8+%,andγinterferon levels of the experimental group were significantly better than those of the control group(P < 0.05).Conclusion:Using ultrasound – guided erector spinae plane block in posterior lumbar surgery in elderly patients can significantly reduce amount of intraoperative analgesics and postoperative pain and improve patient satisfaction.The postoperative analgesic effect is accurate and the adverse reactions are less.At the same time,it has little effect on immune function and has certain clinical value. |
