Effect Of Ultrasound-guided Erector Spinae Plane Block On Analgesia And Early Postoperative Recovery In Patients Undergoing Lumbar Surgery

Objective:To evaluate the effect of ultrasonic guided vertical spinal muscle block(erector spinae plane block,ESPB)combined with general anesthesia combined with automatic control venous analgesia pump(patient controlled intravenous analgesia,PCIA)on perioperative analgesia and early recovery quality of patients undergoing posterior lumbar surgery.Methods:From September 2019 to August 2020,80 patients underwent posterior lumbar surgery under general anesthesia,Gender,Age 18-70,BMI 18-26kg/㎡,ASA grade I or II.Using random numbers,The 80 patients were randomly divided into ultrasound-guided bilateral ESPB group(E group)and control group(C group),The number of patients in each group was 40.Both groups were given general intravenous anesthesia,Before the induction of general anesthesia in ESPB group,Assist the patient in the prone position,Bilateral ESPB.of target segments were then performed under ultrasound guidance PCIA pump(sufentanil 2μg/kg and saline were diluted to 100 ml,after operation 2 ml/h,background dose For 2 ml/times,Lock time is 15 min).The main observation indexes were as follows :1 day before operation(D0),1 day after operation(D1)and 2 days after operation(D2),Five subitems and total scores of the Qo R-40 scale were recorded respectively.The dosage of remifentanil,propofol,induction dose and maintenance dose of cisatracurium were recorded.Separate records;The VAS score of lying h、6h、24h、48h resting and turning over 2 patients after operation.A visual analogue pain score(VAS score)of more than 4 when lying down at rest,The patient starts the self-control button,An additional dose of self-controlled analgesia,If the pain is not alleviated,40 mg of paroxib sodium is added as a remedial analgesic measure,and the times of remedial analgesic administration and effective pressing of the PCIA pump were recorded within 48 hours after operation.Secondary observation indicators: dizziness,nausea and vomiting,skin itching,urinary retention,respiratory inhibition(SPO2<90% or 10 times of respiratory),puncture site hematoma,local anesthetic poisoning and other adverse reactions;The time of first getting out of bed after operation,days of hospitalization,and total medical expenses were recorded in the two groups.Results:Compared to C group,The total Qo R-40 scores of E group D1(174.9±6.9 vs162.5±7.1)and D2(187.3±4.7 vs181.6±4.7)on the first day after operation were significantly increased(P<0.01).Emotional state of the E group on the first and second day after surgery(41.4±1.8 vs 39.4±1.1,43.6±1.2 vs 39.4±2.3),Physical comfort of the E group on the first and second day(53.5 ± 2.2 vs50.4 ± 2.4,57.2 ± 1.1 vs55.2 ± 1.8),Psychological support of the E group on the first and second day(33.0±0.8 vs32.1±0.9,34.2±0.6 vs33.0±0.9),Pain of the E group on the first and second day(31.2±1.4 vs29.2±1.4,32.9±1.1vs32.1 ±1.1),self-care of the E group on the first and second day(15.3 ± 1.8 vs11.5 ±1.7,19.5 ± 1.9vs18.6 ± 1.9)all increased scores(P<0.01).Compared to C group,Remifentanil in E group(992.1 ± 264.2 vs1540.5 ± 426.3),Maintenance dose of cisatracurium in E group(7.6±3.2 vs 10.4±3.3),Total use of cisatracurium in E group(17.9±4.1 vs21.2±4.4)are significantly less than C group(P<0.01).The VAS scores of resting supine and turning exercise in E group(2 h、6h、24h、48h)were significantly lower than those in C group(P<0.01).The effective pressing times of PCIA pump(2.7±1.3vs6.3±1.9)and remedial analgesics(0.7±0.9 vs3.2±1.0)were significantly lower than those of the C group within 48 hours after operation(P<0.01).The first time E group got out of bed after operation(5.3±0.7 vs6.2±0.8),the number of days in hospital(12.1 ±2.1vs15.6±1.2),and the total medical expenses(1.8±0.4)were significantly less than those in C group(P<0.01).The incidence of adverse reactions such as dizziness,nausea and vomiting,skin itching,urinary retention and respiratory inhibition were significantly different between the two groups,but there was no significant difference(P>0.05).E group did not puncture site hematoma,local anesthetic poisoning adverse reactions.Conclusion:Ultrasound guided bilateral vertical spinal muscle block combined with general anesthesia can effectively reduce the amount of analgesic drugs and muscle relaxants in posterior lumbar surgery,and can reduce the number of effective compression of PCIA pump.Reduce the number of remedial analgesics,provide good postoperative analgesic effect,accelerate the recovery rate and improve the quality of early postoperative recovery.