| Objective:The trauma caused by surgical correction of adolescent idiopathic scoliosis(AIS)is enormous,so patients often suffer severe pain after operation.Patient-controlled analgesia(PCA)is the most mature and widely used postoperative pain management strategy for AIS patients.However,opioid related complications such as postoperative nausea and vomiting,pruritus,intestinal obstruction and hyperalgesia still affect most patients.Therefore,it is necessary to combine other analgesic strategies that are safe,effective and have less adverse reactions to reduce the use of opioids,so as to reduce the corresponding adverse reactions and improve the postoperative satisfaction of the patient population.Continuous wound infiltration(CWI)is a technique to block pain conduction by placing a catheter at the surgical incision and continuously perfusing local anesthetics for a period of time after operation.It has been reported that CWI can effectively alleviate postoperative pain and improve patient satisfaction in adult spinal surgery.Erector spinae plane block(ESPB)is an ultrasound-guided regional anesthesia technique.It injects local anesthetics into the myofascial plane between erector spinae and transverse process,which can safely and easily block the dorsal branch of spinal nerve and provide good analgesic effect.It has been reported that the implementation of ESPB in spinal surgery can significantly reduce the consumption of opioids after operation.However,whether the application of CWI or ESPB is effective in postoperative analgesia of AIS is still lack of clinical evidence.Therefore,this study plans to compare the analgesic effects of ropivacaine continuous wound infiltration,single injection of erector spinae plane block and patient-controlled intravenous analgesia after adolescent idiopathic scoliosis surgery through a single center randomized controlled trial,and expect to explore a more suitable postoperative analgesic strategy for AIS patients.Methods: 60 AIS patients undergoing elective surgery were randomly divided into PCA group,CWI group and ESPB group;PCA group was given routine patient-controlled intravenous analgesia after operation.On the basis of intravenous analgesia pump with the same formula as PCA group,CWI group was given 10 ml of 0.375% ropivacaine on both sides before incision suture,and the catheter was placed for continuous infusion of 0.2%ropivacaine for 48 hours.Accordingly,ESPB group was given 20 ml of 0.375%ropivacaine before skin incision,and the same intravenous analgesia pump as PCA group was given after operation.The main results were postoperative visual analogue scale(VAS).The secondary results included the amount of sufentanil during operation,the amount of sufentanil after operation,the number of cases of remedial analgesia,the incidence of nausea and vomiting,incision exudation,sleep disorders and the recovery time of gastrointestinal function.Results: The VAS score of CWI group and ESPB group was significantly lower than the PCA group in the first 6 hours after operation.The VAS score of CWI group was lower than that of PCA and ESPB group at 8-24-hour after operation.The dosage of sufentanil in CWI group and ESPB group was significantly lower than that in PCA group.The incidence of nausea and vomiting in CWI group and ESPB group was significantly lower than that in PCA group.The recovery time of gastrointestinal function in ESPB group was shorter than that in PCA group and CWI group.Conclusions: CWI and ESPB can improve the pain score of AIS patients and reduce the adverse reactions of opioids in the early postoperative period.It is suggested that the use of these two technologies in multimodal analgesia strategy can effectively improve patient satisfaction. |
