摘要目的 探讨胸腰筋膜间平面阻滞(thoracolumbar interfascial plane block,TLIPB)对腰椎融合术后患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)的影响. 方法 择期行后正中入路腰椎融合术的患者42例,按随机数字表法分为单次TLIPB复合PCIA组(TP组)和单纯PCIA组(P组),每组21例.TP组麻醉诱导前行TLIPB,20 min后测定阻滞范围,术毕两组均采用PCIA.记录术后1 h(T1)、6 h(T2)、18 h(T3)、24 h(T4)、48 h(T5)静息和咳嗽VAS评分,镇痛泵按压总次数、有效按压次数、帕瑞昔布追加剂量、镇痛药液输注总量及术后副作用发生率和严重程度. 结果 T1～T3时TP组静息和咳嗽VAS评分均较P组降低(P＜0.05);镇痛泵按压总次数、有效按压次数及帕瑞昔布追加剂量在术后0～1 h明显低于P组(P＜0.05).镇痛药液输注总量及术后副作用两组间差异无统计学意义(P＞0.05). 结论 TLIPB能明显减轻患者腰椎融合术后早期疼痛,提高PCIA的效果,减少副作用.

abstractsObjective To explore the effect of ultrasound-guided single lateral thoracolumbar interfascial plane block (TLIPB) on postoperative patient-controlled intravenous analgesia (PCIA) in patients undergoing posterior midline approach lumbar interbody fusion.Methods Forty-two patients,scheduled for posterior midline approach lumbar interbody fusion,were randomly assigned into two groups (n=21),TLIPB combined with PCIA group (group TP) and PCIA only group (group P).Patients in group TP were subjected to TLIPB before operation,then the area of anesthesia was plotted 20 min after TLIPB.VAS scores during resting and coughing were recorded at 1 h (T1),6 h (T2),18 h(T3),24 h (T4) and 48 h (T5) after operation.The pressing times of PCIA pump,the volume of analgesic drugs,and consumption of Parecoxib and the side-effects were recorded as well.Results TLIPB in group TP induced sensory loss to pinprick in area covered the ventral rami of the thoracolumbar nerves (L1-L4).The VAS scores at both resting and coughing in group TP were significantly lower than those in group P on T1-T3 (P＜0.05).The pressing times of PCIA pump and consumption of Parecoxib were significantly less in group TP than those in group P on 0-1 h postoperatively (P＜0.05).Nausea and emesis were observed in group TP and group P,and did not show any differen (P＞0.05).Conclusions Ultrasound-guided thoracolumbar interfascial plane block for posterior lumbar interbody fusion provides a safe and effective analgesic method for postoperative pain relief.