Objectives: With the rapid development of aging population, the number of elderly patients undergoing posterior lumbar spine surgery continues to increase. Lumbar spine surgery could cause moderate to severe postoperative pain, and the conventional opioid-based analgesia techniques have many side effects, which are barriers to the recovery after surgery of the elderly. Previous studies have demonstrated that erector spinae plane block (ESPB) could bring about favorable analgesia in spinal surgery. As far as the elderly are concerned, the analgesic and recovery effects of ESPB on posterior lumbar spine surgery are not completely clear. This study aims to observe the effects of bilateral ESPB on elderly patients undergoing posterior lumbar spine surgery, and to improve the anesthesia techniques.
Methods: A total of 70 elderly patients of both sex, who were selected from May 2020 to November 2021, scheduled for elective posterior lumbar spine surgery, and in the age of 60-79 years, with American Society of Anesthesiologists class Ⅱ-Ⅲ, were divided into a ESPB group and a control (C) group using a random number table method, with 35 patients each. Before general anesthesia induction, 20 mL 0.4% ropivacaine was injected to the transverse process of L3 or L4 bilaterally in the ESPB group and only saline in the C group. The score of Numerical Rating Scale (NRS) indicating pain at rest and on movement within 48 h after operation, time of first patient control analgesia (PCA), cumulative consumptions of sufentanil within 48 hours, Leeds Sleep Evaluation Questionnaire (LSEQ) scores on the morning of day 1 and day 2 after operation, Quality of Recovery-15 (QoR-15) scores at 24 and 48 h after operation, full diet intake times, perioperative adverse reactions such as intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation were compared between the 2 groups.
Results: A total of 70 patients were enrolled and 62 subjects completed the study, including 32 in the ESPB group and 30 in the C group. Compared with the C group, the postoperative NRS scores at rest at 2, 4, 6, and 12 h and on movementat at 2, 4, and 6 h were lower, time of first PCA was later, sufentanil consumptions were significantly decreased during 0-12 h and 12-24 h after operation, LSEQ scores on the morning of day 1 and QoR-15 scores at 24 and 48 h after operation were higher, full diet intakes achieved earlier in the ESPB group (all P<0.05). There were no significant differences in the incidences of intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation between the 2 groups (all P>0.05).
Conclusions: Providing favorable analgesic effects with reduced opioids consumption, bilateral ESPB for posterior lumbar spine surgery in the elderly patients could also improve postoperative sleep quality, promote gastrointestinal functional restoration, and enhance recovery with few adverse reactions.
目的: 随着人口老龄化迅速发展，接受腰椎后路手术的老年患者持续增多。腰椎手术可引发中重度术后疼痛，以阿片类药物为主的常规镇痛方法不良反应较多，不利于老年患者快速康复。近期研究表明，竖脊肌平面阻滞(erector spinae plane block，ESPB)在脊柱手术中的镇痛效果良好，但对老年腰椎手术的镇痛效果及对康复的影响尚未完全明确。本研究旨在观察双侧ESPB在老年腰椎后路手术中的应用效果，以期为改进麻醉方式提供参考。方法: 选取2020年5月至2021年11月行腰椎后路手术的老年患者70例，性别不限，年龄60~79岁，美国麻醉医师协会(American Society of Anesthesiologists，ASA)II~III级，采用随机数字表法将患者分为ESPB组(行双侧ECPB)和对照(C)组，每组35例。麻醉诱导前，ESPB组于L3或L4双侧横突各注射0.4%罗哌卡因20 mL，C组仅注射等量生理盐水。比较2组术后48 h内静息及活动时疼痛数字评分量表(Numerical Rating Scale，NRS)评分；术后首次自控镇痛(patient control analgesia，PCA)时间、48 h内舒芬太尼累积用量；术后第1和2天里兹睡眠问卷(Leeds Sleep Evaluation Questionnaire，LSEQ)评分；术后24、48 h时15项恢复质量量表(Quality of Recovery-15，QoR-15)评分；术后开始进普通膳食的时间；术中低血压，术后头晕、恶心呕吐、便秘等不良反应的发生情况。结果: 纳入患者70例，62例完成研究，其中ESPB组32例，C组30例。ESPB组术后2、4、6、12 h静息NRS评分及术后2、4、6 h活动NRS评分均低于C组，差异均有统计学意义(均P<0.05)。与C组比较，ESPB组术后第1天LSEQ评分以及术后24、48 h时QoR-15评分更高，术后进普通膳食时间更早，术后首次PCA时间更晚，术后0~12 h、12~24 h舒芬太尼用量更少(均P<0.05)。2组术中低血压，术后头晕、恶心呕吐、便秘等不良反应发生率的差异均无统计学意义(均P>0.05)。结论: 双侧ESPB用于老年腰椎后路手术，镇痛效果良好，可减少阿片类药物用量，改善术后睡眠，促进胃肠功能恢复，加速患者康复，且不良反应少。.
Keywords: analgesia; elderly patient; erector spinae plane block; posterior lumbar spine surgery.