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Abstract：
BACKGROUND: The efficacy and reliability of erector spinae plane block (ESPB) in posterior open lumbar spine surgery has been demonstrated; however, few randomized controlled trials of lumbar ESPB (L-ESPB) in lumbar unilateral bi-portal endoscopic (UBE) surgery have been reported.
METHODS: A total of 120 patients, aged 18 to 65 (who underwent elective lumbar UBE surgery under general anesthesia and exhibited an American Society of Anesthesiologists physical status of I to III) were randomly assigned in a 1:1 ratio to the ESPB group and the Control group. Ultrasound(US)-guided unilateral single-shot 0.25% ropivacaine L-ESPB was performed in the ESPB group, but not in the control group. Postoperative analgesic strategy for all patients: patient controlled intravenous analgesia (PCIA, diluted and dosed with fentanyl alone) was initiated immediately after surgery combined with oral compound codeine phosphate and ibuprofen sustained release tablets (1 tablet containing ibuprofen 200 mg and codeine 13 mg, 1 tablet/q12h) commenced 6 h postoperatively. We collected and compared patient-centred correlates intraoperatively and 48 h postoperatively. The primary outcomes were intraoperative and postoperative opioid consumption and postoperative quality of recovery-15 (QoR-15) scores.
RESULTS: Compared to the control group (n = 56), the ESPB group (n = 58) significantly reduced intraoperative remifentanil consumption (estimated median difference - 280 mcg, 95% confidence interval [CI] - 360 to - 200, p < 0.001, power = 100%); significantly reduced fentanyl consumption at 24 h postoperatively (estimated median difference - 80mcg, 95%[CI] - 128 to - 32, p = 0.001, power = 90%); and significantly enhanced the QoR-15 score at 24 h postoperatively (estimated median difference 11, 95%[CI] 8 to 14, p < 0.001, power = 100%). Compared to the control group, the ESPB group enhanced the resting numeric rating scale (NRS) score up to 8 h postoperatively, and the active movement NRS score up to 4 h postoperatively. The incidence of postoperative nausea and vomiting (PONV) (p = 0.015, power = 70%), abdominal distension (p = 0.024, power = 64%), and muscular calf vein thrombosis (MCVT) (p = 0.033, power = 58%) was lower in the ESPB group than in the control group. Moreover, the occurrence of L-ESPB related adverse reactions was not found herein.
CONCLUSIONS: US-guided L-ESPB reduces intraoperative and 24 h postoperative opioid consumption and improves patients\' QoR-15 scores at 24 h postoperatively. L-ESPB can be safely and effectively utilized in lumbar UBE surgery.
BACKGROUND: Chinese Clinical Trial Registry, ChiCTR2200061908 , date of registration: 10/07/2022. Registry URL.
METHODS: A total of 120 patients, aged 18 to 65 (who underwent elective lumbar UBE surgery under general anesthesia and exhibited an American Society of Anesthesiologists physical status of I to III) were randomly assigned in a 1:1 ratio to the ESPB group and the Control group. Ultrasound(US)-guided unilateral single-shot 0.25% ropivacaine L-ESPB was performed in the ESPB group, but not in the control group. Postoperative analgesic strategy for all patients: patient controlled intravenous analgesia (PCIA, diluted and dosed with fentanyl alone) was initiated immediately after surgery combined with oral compound codeine phosphate and ibuprofen sustained release tablets (1 tablet containing ibuprofen 200 mg and codeine 13 mg, 1 tablet/q12h) commenced 6 h postoperatively. We collected and compared patient-centred correlates intraoperatively and 48 h postoperatively. The primary outcomes were intraoperative and postoperative opioid consumption and postoperative quality of recovery-15 (QoR-15) scores.
RESULTS: Compared to the control group (n = 56), the ESPB group (n = 58) significantly reduced intraoperative remifentanil consumption (estimated median difference - 280 mcg, 95% confidence interval [CI] - 360 to - 200, p < 0.001, power = 100%); significantly reduced fentanyl consumption at 24 h postoperatively (estimated median difference - 80mcg, 95%[CI] - 128 to - 32, p = 0.001, power = 90%); and significantly enhanced the QoR-15 score at 24 h postoperatively (estimated median difference 11, 95%[CI] 8 to 14, p < 0.001, power = 100%). Compared to the control group, the ESPB group enhanced the resting numeric rating scale (NRS) score up to 8 h postoperatively, and the active movement NRS score up to 4 h postoperatively. The incidence of postoperative nausea and vomiting (PONV) (p = 0.015, power = 70%), abdominal distension (p = 0.024, power = 64%), and muscular calf vein thrombosis (MCVT) (p = 0.033, power = 58%) was lower in the ESPB group than in the control group. Moreover, the occurrence of L-ESPB related adverse reactions was not found herein.
CONCLUSIONS: US-guided L-ESPB reduces intraoperative and 24 h postoperative opioid consumption and improves patients\' QoR-15 scores at 24 h postoperatively. L-ESPB can be safely and effectively utilized in lumbar UBE surgery.
BACKGROUND: Chinese Clinical Trial Registry, ChiCTR2200061908 , date of registration: 10/07/2022. Registry URL.
摘要：
背景：已经证明了竖脊肌平面阻滞（ESPB）在后路开放腰椎手术中的有效性和可靠性；但是，很少有关于腰椎ESPB(L-ESPB)在腰椎单侧双门内窥镜(UBE)手术中的随机对照试验报道.
方法：共120例患者，年龄在18~65岁(在全身麻醉下接受了选择性腰椎UBE手术,美国麻醉医师协会的身体状况为I~III)以1:1的比例随机分为ESPB组和对照组.ESPB组进行超声（US）引导单侧单次注射0.25％罗哌卡因L-ESPB，但不在对照组。所有患者的术后镇痛策略：患者自控静脉镇痛（PCIA，手术后立即开始与口服复方磷酸可待因和布洛芬缓释片（1片含有布洛芬200mg和可待因13mg，1片/q12h）术后6h开始。我们收集并比较了以患者为中心的术中和术后48小时的相关性。主要结果是术中和术后阿片类药物的消耗和术后恢复质量15（QoR-15）评分。
结果：与对照组（n=56）相比，ESPB组（n=58）显着降低了术中瑞芬太尼的消耗量（估计中位数差异-280mcg，95％置信区间[CI]-360至-200，p<0.001，功率=100％）;术后24小时显着减少芬太尼的消耗（估计中位数差异-80mcg，95％[CI]-128至-32，p=0.001，功率=90％）；并在术后24小时显着提高了QoR-15评分（估计中位数差异11，95％[CI]8至14，p<0.001，功率=100％）。与对照组相比,ESPB组提高静息数字评定量表（NRS）评分，直至术后8小时，术后4小时内主动运动NRS评分。术后恶心呕吐(PONV)发生率(p=0.015,功率=70%),腹胀（p=0.024，功率=64％），ESPB组的小腿肌肉静脉血栓形成（MCVT）（p=0.033，功率=58％）低于对照组。此外，本文未发现L-ESPB相关不良反应的发生。
结论：美国指导的L-ESPB减少了术中和术后24h的阿片类药物消耗，并改善了患者术后24h的QoR-15评分。L-ESPB可以安全有效地应用于腰椎UBE手术。
背景：中国临床试验注册中心，ChiCTR2200061908,注册日期：2022年7月10日。注册表URL。
方法：共120例患者，年龄在18~65岁(在全身麻醉下接受了选择性腰椎UBE手术,美国麻醉医师协会的身体状况为I~III)以1:1的比例随机分为ESPB组和对照组.ESPB组进行超声（US）引导单侧单次注射0.25％罗哌卡因L-ESPB，但不在对照组。所有患者的术后镇痛策略：患者自控静脉镇痛（PCIA，手术后立即开始与口服复方磷酸可待因和布洛芬缓释片（1片含有布洛芬200mg和可待因13mg，1片/q12h）术后6h开始。我们收集并比较了以患者为中心的术中和术后48小时的相关性。主要结果是术中和术后阿片类药物的消耗和术后恢复质量15（QoR-15）评分。
结果：与对照组（n=56）相比，ESPB组（n=58）显着降低了术中瑞芬太尼的消耗量（估计中位数差异-280mcg，95％置信区间[CI]-360至-200，p<0.001，功率=100％）;术后24小时显着减少芬太尼的消耗（估计中位数差异-80mcg，95％[CI]-128至-32，p=0.001，功率=90％）；并在术后24小时显着提高了QoR-15评分（估计中位数差异11，95％[CI]8至14，p<0.001，功率=100％）。与对照组相比,ESPB组提高静息数字评定量表（NRS）评分，直至术后8小时，术后4小时内主动运动NRS评分。术后恶心呕吐(PONV)发生率(p=0.015,功率=70%),腹胀（p=0.024，功率=64％），ESPB组的小腿肌肉静脉血栓形成（MCVT）（p=0.033，功率=58％）低于对照组。此外，本文未发现L-ESPB相关不良反应的发生。
结论：美国指导的L-ESPB减少了术中和术后24h的阿片类药物消耗，并改善了患者术后24h的QoR-15评分。L-ESPB可以安全有效地应用于腰椎UBE手术。
背景：中国临床试验注册中心，ChiCTR2200061908,注册日期：2022年7月10日。注册表URL。
