Application Of Ultrasound-guided Bilateral Erector Spinae Plane Blocks In Posterior Lumbar Surgery

Objective:To explore and compare the application effect of general anesthesia combined with ultrasound-guided erector spinae plane block(ESPB)and general anesthesia in elective posterior lumbar surgery.Methods:Sixty patients,including 28 males and 32 females,aged 24-70 years old,with body mass index(BMI)of 18-30 kg/㎡,were selected from July 2022 to December 2022 for posterior lumbar surgery at the Spinal surgery department of The Third Bethune Hospital of Jilin University.The patients were classified by the American Society of Anesthesiologists(ASA)grade Ⅰ to Ⅲ.Sixty patients were randomly divided into two groups: group E: general anesthesia combined with ultrasound-guided erector spinae plane block group(n=30),group D: general anesthesia group(n=30).Patients in both groups received rapid intravenous induction and intravenous-inhalation combined maintenance anesthesia.Group E was placed in prone position after general anesthesia induction,and the same senior anesthesiologist administered 20 ml 0.375% ropivacaine hydrochloride on each side of the middle segment of the operation under the guidance of ultrasound visualization.After the operation,patients in both groups received controlled intravenous analgesia(PCIA).Operation time and intraoperative anesthetics(propofol,sufentanil,remifentanil,cisatracurium)were recorded.Heart rate(HR),pulse oxygen saturation(Sp O2)and mean arterial pressure(MAP)were recorded at the time of entry(T0),immediately after intubation(T1),immediately after incision(T2),15 minutes after incision(T3),after surgery(T4),and 5 minutes after extubation(T5).Visual analog scores(VAS)were recorded at 2 hours(T6),6 hours(T7),12 hours(T8),24 hours(T9)and 48 hours(T10)after surgery at resting and turning over.The length of postoperative hospital stay and the first time of getting out of bed were recorded.The occurrence of adverse reactions such as lethargy,nausea and vomiting,respiratory depression,skin pruritus,hematoma at puncture site were recorded within 48 hours after operation.Results:1.There were no significant differences in gender,age,BMI,ASA grading and operation duration between the two groups(P>0.05);2.The dosage of remifentanil and cisatracurium in group E was decreased compared with that in group D,with statistical significance(P<0.05);3.The MAP and HR of group E were lower than those of group D at the time of immediately after incision(T2),15 minutes after incision(T3),after surgery(T4),and 5 minutes after extubation(T5),with statistical significance(P<0.05);4.VAS scores of group E at resting and turning over within 12 hours after surgery were significantly lower than those of group D,with statistical significance(P<0.05);5.The duration of postoperative hospitalization and the first time of getting out of bed in group E were shorter than those in group D,and the difference was statistically significant(P<0.05);6.The incidence of postoperative nausea and vomiting in group E was lower than that in group D,and the difference was statistically significant(P<0.05),while the incidence of lethargy was not statistically significant between the two groups(P>0.05).Conclusion:The use of general anesthesia combined with ultrasound-guided erector spinae plane block in lumbar surgery can alleviate the stress response caused by surgery,reduce the amount of intraoperative anesthesia drugs,relieve postoperative acute pain,and does not increase the incidence of adverse reactions,so as to make patients better and faster recovery,worthy of clinical application.