Wang Jia-Jun, Wang Yan, Li Xue-Fei, Chen Song-Song, Wang Yujie, Sun Peng-Yu, Yang Hai-Kun, Shi Pengcai, Wu Guanghan
Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Shandong Institute of Anesthesia and Respiratory Critical Care, Jinan, Shandong, China.
School of Anesthesiology, Shandong Second Medical University, Weifang, Shandong, China.
Front Med (Lausanne). 2025 Aug 28;12:1630821. doi: 10.3389/fmed.2025.1630821. eCollection 2025.
Lumbar spine surgery is associated with significant postoperative pain and a high incidence of postoperative nausea and vomiting (PONV). Inflammation is a known contributor to PONV risk, and the neutrophil-to-lymphocyte ratio (NLR) is a cost-effective parameter for evaluating systemic inflammation. Erector spinae plane block (ESPB) under ultrasound guidance is a regional anesthesia technique that may reduce postoperative pain, inflammatory responses, and opioid consumption. However, evidence on the relationship between preoperative NLR, PONV, and the effects of ESPB is limited.
This prospective, double-blind, single-center, parallel-group study will enroll 220 patients undergoing elective lumbar spine surgery under general anesthesia. Patients will be stratified by a preoperative NLR threshold of 2 into two equal groups and further randomized to receive either ultrasound-guided ESPB with ropivacaine or a saline control after anesthesia induction. All participants will receive standard PONV prophylaxis with intravenous ondansetron. Primary endpoints include the incidence of nausea, vomiting, and antiemetic requirements in the first and second 24-hour postoperative periods, as well as postoperative NLR. Secondary endpoints include pain scores, intraoperative anesthetic consumption, total postoperative analgesic use, time to first analgesic pump activation, patient satisfaction, recovery times, length of stay, opioid-related side effects, and serum neutrophil extracellular traps.
At the time of submission, the trial is ongoing and in the patient recruitment phase. No results are yet available.
The study is designed to evaluate whether preoperative NLR can serve as a biomarker for PONV and to determine the effect of ESPB on NLR, PONV, and postoperative recovery parameters in lumbar spine surgery patients. The findings may provide evidence for individualized PONV prevention strategies and the perioperative application of ESPB.
This trial will clarify the predictive value of NLR for PONV and assess the efficacy of ESPB in modulating postoperative inflammation and improving recovery in lumbar spine surgery.
ClinicalTrials.gov identifier, NCT06127966.
腰椎手术与显著的术后疼痛以及较高的术后恶心呕吐（PONV）发生率相关。炎症是已知的PONV风险因素，中性粒细胞与淋巴细胞比值（NLR）是评估全身炎症的一个性价比高的参数。超声引导下竖脊肌平面阻滞（ESPB）是一种区域麻醉技术，可能会减轻术后疼痛、炎症反应并减少阿片类药物的使用。然而，关于术前NLR、PONV以及ESPB效果之间关系的证据有限。
这项前瞻性、双盲、单中心、平行组研究将纳入220例接受全身麻醉下择期腰椎手术的患者。患者将根据术前NLR阈值2分为两组，每组人数相等，并在麻醉诱导后进一步随机分为接受超声引导下罗哌卡因ESPB组或生理盐水对照组。所有参与者将接受静脉注射昂丹司琼的标准PONV预防措施。主要终点包括术后第一个和第二个24小时内恶心、呕吐的发生率以及止吐药物的使用情况，以及术后NLR。次要终点包括疼痛评分、术中麻醉药物用量、术后总镇痛药物使用量、首次启动镇痛泵的时间、患者满意度、恢复时间、住院时间、阿片类药物相关副作用以及血清中性粒细胞胞外诱捕网。
在提交本文时，该试验正在进行且处于患者招募阶段。尚无结果。
本研究旨在评估术前NLR是否可作为PONV的生物标志物，并确定ESPB对腰椎手术患者NLR、PONV和术后恢复参数的影响。研究结果可能为个性化的PONV预防策略以及ESPB的围手术期应用提供证据。
本试验将阐明NLR对PONV的预测价值，并评估ESPB在调节腰椎手术术后炎症和改善恢复方面的疗效。
ClinicalTrials.gov标识符，NCT06127966。
