Application Of Multimodal Analgesic Strategy Incorporating Ultrasound-Guided Erector Spinae Plane Block In Posterior Lumbar Surgery Under Enhanced Recovery After Surgery Protocal

Objective:To explore the effect of a multimodal analgesic strategy ultrasound-guided erector spinae plane block（ESPB）in patients undergoing posterior lumbar surgery managed by enhanced recovery after surgery（ERAS）.Methods:A total of 120 patients undergoing elective posterior lumbar surgery from October2021 to August 2022 were selected and randomly divided into groups A,B,and C by random number table method,with 40 cases in each group.All patients on the basis of ERAS protocol,The patients in group A received bilateral ESPB after general anesthesia,and the block drugs was ropivacaine（0.25%）and dexmedetomidine（1μg/kg）.The patients in group B received the same nerve block,and the block drugs was ropivacaine（0.25%）.No nerve block intervention was performed in group C.The visual analogue scale（VAS）scores at resting and active states were recorded at 2 h,12 h,24 h,and 48 h postoperatively.The perioperative consumption of opioids,number of PCIA compression,time to first press of analgesic pump,and rate of remedial analgesia were recorded.Stress index such as blood glucose,cortisol,and hemodynamic changes at different times during the perioperative period were recorded.The postoperative recovery such as first fart and ambulation,days in hospital,satisfaction and the incidence of side effect such as postoperative incision infection and motor nerve block were recorded.Results:1.There were no significant differences in general data such as age,sex,BMI,operation duration,vertebral segment,preoperative ODI score,and surgical procedures among the 3 groups.2.Perioperative pain evaluation:Compared with group C,groups A and B had significantly lower resting and active state VAS scores at 2 h,12 h,18 h and 24 h postoperatively（p<0.01）,Compared with groups B and C,group A had significantly lower resting and active state VAS scores at 18 h and 24 h postoperatively（p<0.01）.3.Perioperative opioid consumption:Compared with group C,groups A and B significantly reduced the consumption of opioids（p<0.01）.4.Postoperative analgesic demand:Compared with group C,groups A and B significantly reduced the time to first press of analgesic pump,had significantly lower rates of remedial analgesia（p<0.01）,significantly delayed the time for the first press of the analgesic pump（p<0.01）,5.Stress level:The blood glucose and cortisol concentrations in groups A and B were lower than those in group C at the time of skin incision and 1 day after operation（p<0.05）;there was no significant difference in MAP and HR among the three groups at before induction（T₀）,after induction（T₁）,and after extubation（T₃）,but at skin incision（T₂）,the MAP and HR of group A and group B were lower than group C（p<0.05）.6.Postoperative recovery indexes:Compared with group C,groups A and B shortened the time of first fart and ambulation（p<0.05）,and improved the satisfaction（p<0.05）.There were no significant differences in the length of hospital stay among the 3 groups.7.Incidence of side effect:There was no statistically significant difference in the incidence of adverse reactions among the 3 groups.8.ODI score and incidence rate of complications at 6 months after operation:There was no significant difference in ODI score and incidence rate of complications at 6 months after operation among the 3 groups.Conclusion:The multimodal analgesic strategy combined with ESPB can be safely and effectively applied to patients undergoing posterior lumbar surgery in ERAS protocol,and ropivacaine combined with DXE for ESPB is a better option.