Asar Sinan, Sarı Sinem, Altinpulluk Ece Yamak, Turgut Mehmet
Department of Anesthesiology and Reanimation, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey.
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Eur Spine J. 2022 Jan;31(1):197-204. doi: 10.1007/s00586-021-07056-z. Epub 2021 Nov 20.
Major lumbar spine surgery causes severe pain in the postoperative period. There are few studies regarding the effect of erector spinae plane block (ESPB) effect on lumbar surgery and its effect is still controversial. Therefore, the study aimed to investigate the effect of ultrasound-guided low thoracic ESPB on opioid consumption and postoperative pain score.
Seventy-eight patients undergoing elective open lumbar spine surgery were randomized into two groups. In ESPB group (n = 35) received ultrasound-guided ESPB and in the control group (n = 35), there was no block. Postoperative opioid consumption as morphine equivalent dose, numerical rating scale, mobilization time, discharge time and side effects, bolus deliveries, rescue analgesia doses were evaluated.
Total opioid consumption as morphine equivalent was higher in the control group than the ESPB group (p = 0.000). Compare with the control group, the numeric rating scale scores were lower in the ESPB group at the 6th, 12th, and 24th hours (p < 0.05). The patient-controlled analgesia button pressing number in the postoperative 24-h period was lower in the ESPB group (p = 0.000). In the postoperative 24-h period, the need for paracetamol in the ESPB group was lower and the difference between the groups was statistically significant (p = 0.008). Rescue analgesia (diclofenac) doses were higher in the control group (p < 0.05). There was no statistically significant difference in terms of side effects and mobilization times.
ESPB is adequate for postoperative analgesia in patients undergoing lumbar spine surgery and can reduce opioid consumption compared with standard analgesia.
腰椎大手术在术后会引起剧烈疼痛。关于竖脊肌平面阻滞（ESPB）对腰椎手术的影响的研究较少，其效果仍存在争议。因此，本研究旨在探讨超声引导下低位胸段ESPB对阿片类药物消耗量和术后疼痛评分的影响。
78例行择期开放性腰椎手术的患者被随机分为两组。ESPB组（n = 35）接受超声引导下的ESPB，对照组（n = 35）不进行阻滞。评估术后阿片类药物消耗量（以吗啡等效剂量表示）、数字评分量表、活动时间、出院时间及副作用、推注次数、补救镇痛剂量。
对照组以吗啡等效剂量表示的总阿片类药物消耗量高于ESPB组（p = 0.000）。与对照组相比，ESPB组在第6、12和24小时的数字评分量表得分较低（p < 0.05）。ESPB组术后24小时内患者自控镇痛按钮按压次数较低（p = 0.000）。术后24小时内，ESPB组对扑热息痛的需求较低，两组间差异有统计学意义（p = 0.008）。对照组的补救镇痛（双氯芬酸）剂量较高（p < 0.05）。在副作用和活动时间方面无统计学显著差异。
ESPB对腰椎手术患者的术后镇痛是足够的，与标准镇痛相比可减少阿片类药物的消耗。
