Effect Of Erector Spinae Plane Block On The Quality Of Early Postoperative Recovery Of Patients Undergoing Lumbar Spinal Surgery

Background and ObjectivePatients with lumbar spinal surgery will experience moderate to severe postoperative pain.Continuous postoperative pain will have a negative impact on functional recovery.At the same time,severe pain will also increase the risk of postoperative complications.Adequate and effective postoperative analgesia is essential for improving function and accelerating recovery.With the rapid development of ultrasound technology,local regional analgesia has become the core component of postoperative multimodal analgesia.Erector spinae plane block(ESPB)is a new ultrasound-guided regional block technique in which local anesthetics are injected into the fascial plane between erector spinae muscle and transverse process.In view of its safety,ease of operation and effectiveness,ESPB has been gradually applied in thoracic,abdominal,lumbosacral,and hip joints and other operations.At present,researches on ESPB mainly focus on thoracic and abdominal surgery and the consumption of postoperative analgesics.Researches on ESPB in lumbosacral surgery are still in the exploratory stage,and ESPB in improving the quality of early recovery after lumbar spine surgery has not been verified.The purpose of this study was to observe whether ESPB can improve the quality of early recovery after lumbar spinal surgery,and to observe the effect of ESPB on postoperative patient-controlled intravenous analgesia opioid consumption and pain scores at different time points after surgery,in order to explore whether ESPB can be used as a part of multimodal analgesia after lumbar spinal surgery.Subjects and MethodsFrom September 2019 to January 2020,sixty-eight patients of both sexes,aged 18～65 years,with body mass index of 18.5～28.0 kg/m2,of American Society Anesthesiologists physical status I and II,undergoing elective lumbar spinal surgery in the First Affiliated Hospital of Zhengzhou University,were randomly divided into erector spinae plane block group(ESPB group)and control group(GA group)using a random number table method,34 cases in each group.ESPB group:Thirty minutes before induction of general anesthesia,bilateral ESPB was performed with 0.33%ropivacaine hydrochloride 20ml at L3 level under ultrasound guidance;GA group did not receive erector spinae block.Patients in both groups were treated with induction of intravenous anesthesia,maintained with intravenous inhalation combined anesthesia,and used sufentanil for patient-controlled intravenous analgesia(PCIA)after operation.The QoR-15 scores were evaluated on the first day before operation and the first day after operation;Numerical rating scale(NRS)pain score was evaluated at rest and exercise state at 1 h、6 h、12 h、24 h and 48 h after operation;the cumulative consumption of sufentanil PCIA at 0-24 h and 24-48 h after operation;The number of times of pressure of analgesia pump 48 hours after operation;Postanesthesia care unit(PACU)discharge time and operation time;the incidence of postoperative nausea and vomiting and patient satisfaction;adverse reactions related to ESPB were recorded.ResultsA total of 65 patients(32 in the ESPB group and 33 in the GA group)completed the study,3 patients were removed.There was no significant difference in general information between the two groups of patients(P>0.05).There was no significant difference in QoR-15 score between the two groups before operation(P>0.05).Compared with GA group,QoR-15 score was higher in ESPB group on the first day after operation;NRS pain score at rest and exercise was lower at 1 h、6 h and 12 h after operation;PCIA consumption of 0-24h sufentanil was less;the differences were statistically significant(P<0.05).There was no statistically significant difference in NRS score at rest and exercise at 24h and 48h postoperatively,and the PCIA consumption of sufentanil at 24-48h between the two groups(P>0.05).There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups(P>0.05).The postoperative satisfaction of the ESPB group was higher than that of the GA group,and the difference was statistically significant(P<0.05).There were no ESPB-related adverse reactions in either group.Conclusion1.Erector spinae plane block improves the quality of early recovery of the patients after lumbar spinal surgery.2.Erector spinae plane block reduces the postoperative pain and the use of opioid in the patients undergoing lumbar spinal surgery.3.Erector spinae plane block improves the postoperative satisfaction of patients with lumbar spinal surgery,which can be used as a part of multimodal analgesia after lumbar surgery.