| Background and purpose:Open posterior lumbar surgery is one of the common operative methods used to treat patients with severe pain and walking disorders caused by compression of lumbar spinal nerves.This kind of surgery not only has a larger trauma,requires a deep anesthesia and full muscle relaxation during the surgery,and has severe pain after the surgery.At the same time,most of these patients are elderly and advanced age patients,so how to do a good job in the stable management of anesthesia and speed up early postoperative rapid recovery are a huge challenge for anesthesiologists.On the one hand,general anesthesia combined with regional anesthesia can enhance the anesthesia management during operation,on the other hand,it can provide good preventive multimodal analgesia.The ultrasound-guided erector spinae plane block(ESPB)is a recently-described technique for providing thoracic analgesia,which has been widely used in the treatment of acute and chronic pain such as chest and abdomen.ESPB can block the posterior rami of spinal nerves and provide low back tissue anesthesia for posterior lumbar surgery.The objective of this research was to explore the efficacy and advantage of ESPB in enhancing early recovery of posterior lumbar surgery.Methods:From April 2018 to May 2019,a total of 60 patients undergoing open posterior lumbar decompression surgery under general anesthesia who were ASA physical status I-III and18 to 80 years old were randomized in a 1:1 ratio to two groups.All patients provided written informed consent for the study.In the T12 group,patients received pre-operative bilateral ESPB with 0.3% ropivacaine 25 m L at the T12 level;in the control group,patients did not receive the block.All participants were observed until hospital discharge and followed up to 1-month after surgery.The primary outcome was the Modified Observer’s Assessment of Alertness/Sedation(MOAA/S)score at 10 minutes after extubation.Secondary outcomes included intraoperative sufentanil consumption,postoperative morphine consumption,first time to ambulation after surgery,hospital length of stay after surgery and incidence of pain 1-month after surgery.Results:The mean(SD)MOAA/S scores at 10 minutes after extubation were 4.5 ± 0.5(95% CI,4.3 to 4.7),and 3.8 ± 0.5(95% CI,3.6 to 4.0)in the T12 and control groups(P <0.001),respectively.Intraoperative sufentanil consumption(20 ± 7.0 vs.25 ± 5.6 ug,P = 0.007),duration of anesthesia recovery(35 ± 1.5 vs.45 ± 4.6min,P < 0.001),postoperative morphine consumption(9.1 ± 2.1 vs.21.8 ± 3.4mg,P = 0.003),incidence of pain 1-month after surgery(46.7% vs.92.9%,p =0.001)were lower in the T12 group than in the control group.Although first time to ambulation after surgery was sooner in the T12 group than in the control group(72(72-96)vs.96(78-111)h,P=0.003),hospital length of stay was similar(6(5-9.3)vs.6.5(6-11.3)d,P=0.054).Conclusion:The application of pre-operative bilateral ESPB in patients can enhance early recovery after open posterior lumbar surgery,which is due to not only reduction in intraoperative anesthetic consumption and enhance anesthesia emergence,but also provide better analgesia and ambulation after surgery. |
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