Mariappan Ramamani, Gandham Edmond Jonathan, Stephenson Sam Jenkins, Cherian Noble E, Lionel Karen Ruby
Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
J Neurosci Rural Pract. 2021 Jan;12(1):213-216. doi: 10.1055/s-0040-1721544. Epub 2021 Jan 29.
Pain at the autologous bone graft site from the posterior-superior iliac spine (PSIS) is severe enough to affect the postoperative ambulation. It adds to the morbidity of the surgical procedure. Inadequate pain management at the graft site not only affects the postoperative recovery but also can lead to chronic pain. We report the use of ultrasound (US)-guided lumbar erector spinae plane block (ESPB), to deliver effective analgesia for this pain. Patients who underwent occipitocervical fusion (OCF) and C1-C2 fusion using PSIS for atlantoaxial dislocation (AAD)/odontoid fracture from January to March 2020 and who received US-guided lumbar ESPB were retrospectively studied. All the necessary data were collected from the inpatient hospital, anesthesia, and the acute pain service records. A total of six patients received lumbar ESPB, of which one received a single shot injection, and the rest five had a catheter placement for postoperative analgesia. The average volume of intraoperative and postoperative bolus was 27(range: 15-30) and 21 (range: 15-30) mL of 0.2% ropivacaine, respectively. All patients achieved a unilateral sensory blockade ranging from L1 to L3 dermatomes. None of our patients had a numerical rating scale of > 4 on movement at any time point during the first 48 hours except in one, in whom only a single shot bolus was given. No complications related to ESPB were noted. All were ambulated on the second postoperative day except one. The average length of hospital stay was 6 (range: 4-10) days. US-guided lumbar ESPB provides excellent analgesia for PSIS bone graft site pain and promotes early ambulation.
来自后上棘（PSIS）的自体骨移植部位疼痛严重到足以影响术后行走。这增加了手术的发病率。移植部位疼痛管理不当不仅会影响术后恢复，还可能导致慢性疼痛。我们报告使用超声（US）引导下的腰大肌平面阻滞（ESPB）来有效缓解这种疼痛。对2020年1月至3月因寰枢椎脱位（AAD）/齿状突骨折接受枕颈融合术（OCF）和使用PSIS进行C1-C2融合术且接受US引导下腰大肌平面阻滞的患者进行回顾性研究。所有必要数据均从住院病历、麻醉记录和急性疼痛服务记录中收集。共有6例患者接受了腰大肌平面阻滞，其中1例接受单次注射，其余5例放置导管用于术后镇痛。术中及术后推注的0.2%罗哌卡因平均体积分别为27（范围：15 - 30）和21（范围：15 - 30）mL。所有患者均实现了从L1至L3皮节的单侧感觉阻滞。除1例仅接受单次推注的患者外，我们的患者在术后48小时内的任何时间点运动时数字评分量表均未超过4分。未发现与腰大肌平面阻滞相关的并发症。除1例患者外，所有患者均在术后第二天开始行走。平均住院时间为6（范围：4 - 10）天。US引导下的腰大肌平面阻滞为PSIS骨移植部位疼痛提供了出色的镇痛效果，并促进了早期行走。
