Application Of Nalbuphine Combined With Ropivacaine In Erector Spinae Plane Block For Posterior Lumbar Surgery

Objective: To observe the effect of nalbuphine combined with ropivacaine in erector spinae plane block for posterior lumbar spine surgery,and to provide a reference for the development of perioperative analgesic strategies for patients undergoing posterior lumbar spine surgery.Methods: Sixty-nine patients who underwent elective posterior lumbar surgery,were selected and randomly divided into three groups,Group G,Group R and Group N,with23 cases in each group.All patients underwent ultrasound scan and puncture before the start of surgery after anesthesia,and all carried PCIA after surgery.Patients in group R underwent ultrasound-guided bilateral ESPB with 20 ml of 0.375% ropivacaine on each side,patients in group N underwent ultrasound-guided bilateral ESPB with 20 ml of 0.375%ropivacaine containing nalbuphine 10 mg injected on each side,and patients in group G underwent bilateral ultrasound scan,simulated guided puncture needle into the subcutaneous 1cm,and injection of 1ml of saline.Intraoperative MAP and HR changes,anesthetic dosage,time of extubation at the end of surgery;time of first postoperative remedial analgesia;resting and turning NRS scores at different postoperative points;dose of sufentanil consumption at various times during the 24 h postoperative period;complications and postoperative recovery were recorded for the three groups.Results:1.The time to first postoperative remedial analgesia in the three groups was statistically significant in a two-by-two comparison(P<0.001).2.Both group N and group R could reduce intraoperative sufentanil and remifentanil dosage and shorten extubation time,and differences were statistically significant(P<0.05),and there was no statistical significance(P>0.05)between group N and group R.3.The resting NRS scores at 1,2,4,8,and 12 h postoperatively were significantly lower in patients in groups N and R than in group G.The difference was statistically significant(P<0.05),and there was no statistically significant difference between groups N and R(P>0.05).At 24 h postoperatively,the resting NRS scores in group N were significantly lower than those in groups R and G,and the difference was statistically significant(P<0.05).The turning NRS scores of patients in the groups N and R were significantly lower than those in the group G at 1,2 and 4h after surgery,and differences were statistically significant(P<0.05),and there was no statistically significant difference between the groups N and R(P>0.05).At 8h postoperatively,the group N had a significantly lower turning NRS score than the groups R and G,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the comparison of the turning NRS scores at the remaining time points in the three groups(P>0.05).4.When comparing the dose of sufentanil consumption at each postoperative time,from0 to 4 h postoperatively,there was a significant reduction in the groups N and R compared with the group G(P<0.001),and the difference between the groups N and R was no statistically significant(P=0.150).From 12 to 24 h postoperatively,the difference was no statistically significant in all three groups compared(P>0.05).The two-by-two comparisons between the three groups for the remaining time periods were statistically different(P<0.05).5.The incidences of postoperative nausea,vomiting and skin pruritus were significantly lower in groups N and R than in group G.The differences were statistically significant(P<0.05).The time of first getting out of bed and the time of first venting were significantly earlier in groups N and R than in group G(P<0.05).Conclusion: Nalbuphine combined with ropivacaine in erector spinae plane block can significantly enhance the perioperative analgesic effect of posterior lumbar spine surgery,prolong postoperative analgesia,reduce patients’ need for analgesics after surgery,reduce the occurrence of complications such as nausea,vomiting and pruritus,and accelerate postoperative recovery.