Lal Arpita, Singh Manish K, Kanaujia Shashank Kumar, Mishra Neel Kamal, Singh Brijesh Pratap, Singh Gyan Prakash
Anesthesiology, King George's Medical University, Lucknow, IND.
Anesthesiology and Critical Care, King George's Medical University, Lucknow, IND.
Cureus. 2024 Jul 17;16(7):e64775. doi: 10.7759/cureus.64775. eCollection 2024 Jul.
Lumbar spine surgery is associated with a significant degree of moderate-to-severe perioperative pain which can be alleviated by using different pain-relieving modalities; of these, erector spinae plane block and intrathecal morphine have promise.
To compare the analgesic efficacy between intrathecal morphine (ITM) versus erector spinae plane block (ESPB) for perioperative analgesia in patients undergoing lumbar spine surgery.
A total of 74 patients aged between 20 and 65 years of either sex were posted for elective lumbar spine surgery. Patients were divided into two groups: Group A patients received 0.3 mg intrathecal morphine and Group B received bilateral erector spinae plane block at L3 level by using 30 mL of 0.5% ropivacaine before starting the surgery for perioperative analgesia. In the perioperative period, pain was assessed by hemodynamic parameters (heart rate and mean arterial pressure), numeric rating scale (NRS), and patient satisfaction score. Result: The difference in heart rate and mean arterial pressure was found to be statistically significant between groups at three, six, 12, and 24 hours (p<0.05). The patients who required rescue analgesia in Group A and Group B were 23 (62.2%) and 37 (100%) patients in the first 24 hours. The rate of complication was higher in Group A than in Group B (45% vs 5.4%). The patient satisfaction score was found to be better in Group A than in Group B.
Intrathecal morphine provides more substantial and extended analgesia up to 48 hours postoperatively as compared to erector spinae plane block.
腰椎手术会导致患者在围手术期出现相当程度的中重度疼痛，可通过不同的镇痛方式缓解；其中，竖脊肌平面阻滞和鞘内注射吗啡具有应用前景。
比较鞘内注射吗啡（ITM）与竖脊肌平面阻滞（ESPB）在腰椎手术患者围手术期镇痛中的效果。
选取74例年龄在20至65岁之间、性别不限、拟行择期腰椎手术的患者。将患者分为两组：A组患者接受0.3mg鞘内注射吗啡，B组在手术开始前于L3水平使用30mL 0.5%罗哌卡因行双侧竖脊肌平面阻滞以进行围手术期镇痛。在围手术期，通过血流动力学参数（心率和平均动脉压）、数字评分量表（NRS）和患者满意度评分来评估疼痛程度。结果：在术后3小时、6小时、12小时和24小时，两组患者的心率和平均动脉压差异有统计学意义（p<0.05）。在最初24小时内，A组和B组需要补救性镇痛的患者分别为23例（62.2%）和37例（100%）。A组的并发症发生率高于B组（45%比5.4%）。A组的患者满意度评分高于B组。
与竖脊肌平面阻滞相比，鞘内注射吗啡在术后48小时内可提供更有效、更持久的镇痛效果。
