Kanna Rishi M, Ramachandran Karthik, Subramanian J Balavenkat, Shetty Ajoy P, Rajasekaran S
Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Spine J. 2023 Jan;23(1):6-13. doi: 10.1016/j.spinee.2022.04.010. Epub 2022 Apr 22.
Posterior cervical spine surgery (PCSS) are typically open surgeries and entail significant postoperative pain. Current perioperative pain management in PCSS is reliant on multimodal analgesia. While perioperative epidural anesthetic infusion can be used in lumbar surgeries, this is not an option in the cervical spine. Pre-emptive regional analgesia through erector spinae plane block (ESPB) has shown significant perioperative analgesic benefits in lumbar spine surgeries. There are no such clinical studies in PCSS.
To assess the safety and efficacy of ultrasound-guided ESPB for perioperative analgesia in PCSS.
Prospective, randomized controlled, double-blinded study.
Eighty-six patients requiring sub-axial PCSS with or without instrumentation were randomized into two groups, those who underwent ESPB with multimodal analgesia (case) and those with only multimodal analgesia (control).
Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization and complications were recorded.
After anesthesia and prone position, case patients received ultrasound-guided ESPB at the T1 level using 15 ml of 0.25% bupivacaine and 8 mg Dexamethasone bilaterally while the control patients received only standard postoperative multimodal analgesia.
There were 43 patients in each group; the two groups were identical in demographic and surgical profile. The intraoperative opioid consumption (119.53±40.35 vs. 308.6±189.78; p<.001) in mcg), muscle relaxant usage (50.00±0.00 mg vs. 59.53±3.75 mg, p<.001), surgical duration (124.77±26.63/ 156.74±37.01 min; p<.01) and intraoperative blood loss (310.47±130.73 ml vs. 429.77±148.50 ml; p<.05) were significantly less in the ESPB group. In the postoperative period, the control group's pain score was significantly higher (p<.001). The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores also showed significant differences between the case and control groups (p<.001). The mean time required to ambulate (sitting/walking) was statistically less in cases (15.81±6.15/20.72±4.02 h) when compared to controls (16.86±6.18/ 23.05±8.88 h; p<.001).
In patients undergoing PCSS, ESPB is a safe and effective technique with better outcomes than standard multimodal analgesia alone, in terms of reduced intraoperative opioid requirements and blood loss, better postoperative analgesia and early mobilization.
颈椎后路手术（PCSS）通常为开放性手术，术后疼痛明显。目前PCSS围手术期疼痛管理依赖多模式镇痛。虽然围手术期硬膜外麻醉输注可用于腰椎手术，但颈椎手术中无法采用。通过竖脊肌平面阻滞（ESPB）进行的超前区域镇痛在腰椎手术中已显示出显著的围手术期镇痛效果。PCSS中尚无此类临床研究。
评估超声引导下ESPB用于PCSS围手术期镇痛的安全性和有效性。
前瞻性、随机对照、双盲研究。
86例需要进行颈椎后路非寰枢椎手术（无论是否使用内固定）的患者被随机分为两组，一组接受ESPB联合多模式镇痛（病例组），另一组仅接受多模式镇痛（对照组）。
评估人口统计学和手术数据（失血量、手术时间、围手术期总阿片类药物消耗量、使用的肌肉松弛剂）。术后记录手术部位疼痛、警觉性评分、满意度评分、活动时间和并发症。
麻醉并处于俯卧位后，病例组患者在T1水平接受超声引导下ESPB，双侧使用15 ml 0.25%布比卡因和8 mg地塞米松，而对照组患者仅接受标准术后多模式镇痛。
每组各有43例患者；两组在人口统计学和手术特征方面相同。ESPB组术中阿片类药物消耗量（119.53±40.35 vs. 308.6±189.78；p<0.001，单位为mcg）、肌肉松弛剂使用量（50.00±0.00 mg vs. 59.53±3.75 mg，p<0.001）、手术持续时间（124.77±26.63/156.74±37.01分钟；p<0.01）和术中失血量（310.47±130.73 ml vs. 429.77±148.50 ml；p<0.05）均显著低于对照组。术后，对照组的疼痛评分显著更高（p<0.001）。改良观察警觉性/镇静评分（MOASS）和满意度评分在病例组和对照组之间也存在显著差异（p<0.001）。与对照组（16.86±6.18/23.05±8.88小时；p<0.001）相比，病例组患者坐起/行走的平均活动时间在统计学上更短（15.81±6.15/20.72±4.02小时）。
对于接受PCSS的患者，ESPB是一种安全有效的技术，与单纯标准多模式镇痛相比，在减少术中阿片类药物需求和失血量、改善术后镇痛和早期活动方面具有更好的效果。
