【摘要】 目的观察超声引导竖脊肌平面阻滞在椎体成形术(percutaneous vertebroplasty, PVP)或经皮穿刺球囊扩张椎体后凸成形术(percutaneous kyphoplasty, PKP)麻醉中的作用。方法选择诊断为椎体压缩性骨折(OVCFs)择期行PVP或PKP的患者71例,其中男13例,女58例,年龄57～93岁,体重46～89 kg, ASAⅠ～Ⅲ级。患者随机分为2组,分别行竖脊肌平面阻滞(E组,n=36),或局部浸润麻醉(C组,n=35)。E组在超声引导下于病椎两侧行竖脊肌平面阻滞,每侧注入0.4%罗哌卡因注射液15 mL;C组患者由手术医生于病椎两侧行局部麻醉,每侧用1%利多卡因15 mL。测试两组患者麻醉后皮区感觉阻滞效果,记录术中其它药物用量;记录两组患者麻醉前(t1)、PVP/PKP工作套管软组织穿刺时(t2)、套管入椎弓根后(t3)、套管进椎体内时(t4)、球囊扩张时(t5)、骨水泥注入后(t6)的VAS评分;记录两组患者术后2、6、12、24 h静态和动态VAS评分;记录两组患者术后下肢有无感觉异常和双下肢肌力,记录开始下地行走的时间;记录有无其它并发症。结果两组患者皮区阻滞效果比较,差异无统计学意义(P>0.05);t3、t4、t5时段,E组VAS评分均较C组低,两组VAS组间比较差异有统计学意义(均P<0.05),t2、t6时段两组间VAS评分比较差异无统计学意义(均P>0.05);两组患者术中补救浸润麻醉人数比较,差异有统计学意义(P<0.05);两组患者术后2、6、12、24 h静态和动态VAS评分比较差异均无统计学意义(均P>0.05)。结论超声引导竖脊肌平面阻滞在PVP/PKP术中麻醉镇痛效果良好。更多还原

【Abstract】 Objective To investigate the analgesic effect of erector spinae plane(ESP)blockade in patients undergoing percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fractures(OVCFs).Methods Seventy-one OVCFs patients(ASAⅠ-Ⅲ)undergoing PVP or PKP were randomly assigned into 2 groups.The ESP group(n=36)received ultrasound(US)-guided bilateral ESP blockade with 0.4% ropivacaine(15 mL)at each side.In the control group(n=35),1% lidocaine(15 mL)was injected around injured vertebra for local anesthesia.Sensory blockade of the skin area was assessed.Intraoperative VAS scores were recorded at the time points of before anesthesia(t1),PVP/PKP working cannula puncturing through soft tissue(t2),cannula passing into pedicle(t3),cannula entering vertebral body(t4),ball expansion(t5),and injection of bone cement(t6).We also measured the requirement of extra analgesics during the surgery.Both static and dynamic VAS scores were recorded 2,6,12 and 24 hours after surgery, respectively.Muscle strength of lower limbs and time to mobilization were recorded.Occurrence of limb paresthesia and complications were also reported.Results The degree of sensory blockade was identical in the two groups(P>0.05).During the surgery, the VAS scores in ESP group were significantly lower than those of control group at t3,t4,and t5(all P<0.05),which referred to the time of working cannula entering the pedicle and vertebral body.The VAS scores recorded at t2 and t6 showed no significant difference between the two groups(P>0.05).The number of the patients who needed additional anesthesia introperatively was significantly smaller in ESP group than in control group(P<0.05).After the surgery, both static and dynamic VAS scores showed no significant differences between the two groups at all tested time points(2,6,12,24 h)(all P>0.05).Both groups showed no occurrence of local anesthetic intoxication and complications related to the blockade.Conclusion US-guided ESP blockade increases analgesic efficiency and improves satisfaction in patients undergoing PVP or PKP.更多还原