T12 Vertebral Erector Spinae Plane Block For Postoperative Analgesia And Early Recovery After Lumbar Spine Surgery In Elderly Patients

Background and PurposeLumbar spine surgery is often associated with moderate to severe postoperative pain.As the heart and brain function decline,severe postoperative pain may increase the risk of complications such as myocardial ischemia and postoperative delirium(POD),and prolong ambulation time in elderly patients,which are not conducive to early recovery.Ultrasound(US)-guided Erector Spinae Plane block(ESPB)has a promising application in spine surgery because of its extensive blocking the dorsal rami of the spinal nerves.Therefore,this experiment was planned to explore the effect of T12 ESPB on postoperative analgesia and early recovery after posterior lumbar spine surgery in elderly patients.MethodsA total of 230 patients(age ≥60 years old)who needed posterior lumbar spine surgery due to lumbar disc herniation or lumbar spinal stenosis were randomly divided into ESPB group(GE group,n=115)and general anesthesia group(G group,n=115).Both groups received standard general anesthesia during surgery.After induction,Bilateral US-guided ESPB was performed on T12 vertebral in GE group,a total volume of 20 m L of 0.4% ropivacaine was injected on each side,and there was no intervention in G group.Postoperative analgesia was provided with intravenous Flurbiprofen Axetil Injection 100 mg twice a day.Rescue analgesia was provided with intramuscular Tramadol 100 mg whenever the numeric rating scales(NRS)pain score ≥4.The primary outcomes were NRS score and Tramadol consumption within 72 hours postoperatively.Secondary outcomes included intraoperative remifentanil consumption,hemodynamic parameters,extubation time,the Riker sedation-agitation score(SAS)after extubation,incidence of delirium,incidence of Postoperative nausea and vomiting(PONV),complications of ESPB,ambulation time,and length of hospital stay after surgery.ResultsSeventeen patients withdrew from the experiment,and finally 105 patients in GE group and 108 patients in G group were included in the data analysis.The NRS score of GE group was lower than that of G group within postoperative 48 hours(P<0.01),and Tramadol consumption was significantly reduced within 72 hours(P<0.001).The amount of remifentanil in GE group was lower than that in G group(P<0.001),and the hemodynamic fluctuation was more stable.Compared with G group,the extubation time,SAS after extubation,ambulation time,and length of hospital stay after surgery were all lower than those in G group(P<0.05).POD occurred in 7 cases(6.6%)in GE group and 10 cases(9.3%)in G group,the difference was not statistically significant(P>0.05).The incidence of PONV in the GE group was lower than G group(P<0.05).The GE group had no ESPB complications.ConclusionsBilateral US-guided T12 vertebral ESPB can reduce the postoperative 48 hours NRS score and perioperative opioid consumption,stabilize intraoperative hemodynamics,and shorten the extubation time,ambulation time,and length of hospital stay after surgery,which is conducive to the early recovery of elderly patients.