| Objective:To investigate the effectiveness and safety of low-volume multi-point lumbar spine plane block（ESPB）in posterior lumbar spine surgery in elderly patients.Methods:Select 60 elderly patients with lumbar intervertebral fusion in two segment of lumbar degenerative disease,unlimited gender,age 65～75 years,body mass index（BMI）18～30 kg×m-2,ASA（American Society Anesthesiologists,ASA）Ⅰ～Ⅲ.According to the random number table method,the chief resident anesthesiologist divided the eligible patients into group C（general anesthesia group）and group E（general anesthesia combined ESPB group）.Patients in both groups were given general anesthesia.Patients in group E were placed in the prone position after induction of anesthesia.Group E patients were placed in prone position after induction of anesthesia,and bilateral low-volume multi-point ESPB was injected with 10 m L ropivacaine at each point under ultrasound guidance by the same anesthesiologist who was not involved in anesthesia management（a total of 4 blocking points）.After the operation,the two groups of patients were treated with intravenous analgesia pump.The operation time,anesthesia time and bleeding volume were recorded.The dosage of anesthetic（propofol,sevoflurane,sufentanil,cisatracurium）were recorded.Mean arterial pressure（MAP）and Heart rate（HR）were recorded before anesthesia（T0）,5 minute before skin incision（T1）,5 minute after skin incision（T2）,2hours after skin incision（T3）,postoperative（T4）,after extubation（T5）,before leaving the recovery chamber（T6）,and 4 hours after surgery（T7）.Numerical rating scale（NRS）was recorded before leaving the recovery room（T6）,4 hours after surgery（T7）,24 hours after surgery（T8）,48 hours after surgery（T9）.Number of additional analgesia and number of remedial analgesia were recorded within 48 hours.Adverse reactions and postoperative wound healing were recorded within 48 hours.Results:1.There was no statistically significant difference between the two groups in ASA,BMI,gender,age,anesthesia time,operation time and bleeding volume（P>0.05）.2.There was no significant difference in the dosage of cisatracurium and propofol between the two groups（P>0.05）,and the difference in the dosage of sevoflurane and sufentanil was statistically significant（P<0.05）,and the dosage of sevoflurane and sufentanil in group E was less than that in group C.3.The MAP and HR in 5 minute before skin incision（T1）and 2hours after skin incision（T3）of two groups were lower than the MAP and HR before anesthesia（T0）（P<0.05）.The hemodynamics of patients in group C showed significant fluctuations at 5 minute after skin incision（T2）,and MAP and HR were higher than those in group E at 5 minute after skin incision（T2）（P<0.05）.There was no significant fluctuation in hemodynamics between the two groups from postoperative（T4）to 4 hours after surgery（T7）,and the difference was not statistically significant（P>0.05）.4.The NRS score of group E before leaving the recovery chamber（T6）was significantly lower than that of group C（P<0.05）.There was no statistically significant difference in the NRS score of the two groups at 4 hours（T7）,24 hours（T8）and 48 hours（T9）after surgery（P>0.05）.The number of additional analgesia and the number of remedial analgesia by the analgesia pump within 48 hours after surgery in group E was significantly less than that in group C,and the difference was statistically significant（P<0.05）.5.There was no statistically significant difference between the two groups in adverse reactions（nausea,vomiting,drowsiness）and postoperative wound infection within 48 hours（P>0.05）.Conclusion:The application of ultrasound-guided low-volume multi-point lumbar spine ESPB in lumbar spine surgery in elderly patients can reduce the stress response,avoid hemodynamic fluctuations caused by surgical stimulation,reduce the amount of analgesic and sedative drugs during the operation.At the same time,it can relieve acute pain after surgery,which is worthy of popularization and application in lumbar spine surgery in elderly patients. |
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