OBJECTIVE: We evaluated the impact of varying ES distances for ESPB on Numerical Rating Scale (NRS) measures of postoperative pain within the ERAS protocol.
METHODS: Retrospective observational study.
METHODS: Adult patients who underwent elective lumbar spine fusion surgery.
METHODS: Primary outcome measures include the comparative postoperative NRS scores across groups at immediate (T1), 24 (T2), 48 (T3), and 72 (T4) hours postsurgery. For secondary outcomes, a propensity matching analysis compared these outcomes between the ERAS and non-ERAS groups, with opioid-related recovery metrics also assessed.
METHODS: All included patients were assigned to one of three ERAS groups according to the ES distance: Group 1 (G1, ES > 3 segments), Group 2 (G2, ES = 2-3 segments), and Group 3 (G3, ES<2 segments). Each patient underwent a bilateral ultrasound-guided ESPB with 60 mL of diluted ropivacaine or bupivacaine.
RESULTS: Patients within the ERAS cohort reported mild pain (NRS < 3), with no significant NRS variation across G1 to G3 at any time. Sixty-five patients were matched across ERAS and non-ERAS groups. The ERAS group exhibited significantly lower NRS scores from T1 to T3 than the non-ERAS group. Total morphine consumption during hospitalization was 26.7 mg for ERAS and 41.5 mg for non-ERAS patients. The ERAS group resumed water and food intake sooner and had less postoperative nausea and vomiting.
CONCLUSIONS: ESPBs can be effectively administered at or near the mid-surgical level to the low thoracic region for lumbar spine surgeries. Given challenges with sonovisualization, a lumbar ESPB may be preferred to minimize the risk of inadvertent pleural injury.
目的:我们评估了ESPB的不同ES距离对ERAS方案中术后疼痛的数值评定量表(NRS)测量值的影响。
方法:回顾性观察研究。
方法:接受选择性腰椎融合手术的成年患者。
方法:主要结果指标包括即刻(T1)各组的比较术后NRS评分,24(T2),48(T3),手术后72(T4)小时。对于次要结果,倾向匹配分析比较了ERAS和非ERAS组的这些结果,与阿片类药物相关的恢复指标也进行了评估。
方法:根据ES距离将所有纳入的患者分为三个ERAS组之一:第1组(G1,ES>3段),第2组(G2,ES=2-3段),和第3组(G3,ES<2段)。每位患者接受双侧超声引导的ESPB,使用60mL稀释的罗哌卡因或布比卡因。
结果:ERAS队列中的患者报告轻度疼痛(NRS<3),从G1到G3在任何时候都没有显著的NRS变化。65名患者在ERAS和非ERAS组中进行了匹配。从T1到T3,ERAS组的NRS评分明显低于非ERAS组。ERAS患者住院期间吗啡总消耗量为26.7mg,非ERAS患者为41.5mg。ERAS组较早恢复水和食物摄入,术后恶心和呕吐较少。
结论:ESPBs可以有效地在或接近手术中期水平的下胸区域用于腰椎手术。考虑到超声可视化的挑战,腰椎ESPB可能是首选,以最大程度地减少意外胸膜损伤的风险。