2023 年第 5 期 第 18 卷

罗哌卡因联合低剂量纳洛酮胸腰筋膜平面阻滞用于腰椎融合术后镇痛的效果观察

Effect of thoracolumbar interfascial plane block with ropivacaine combined with low-dose naloxone on analgesia after lumbar spinal fusion

作者：闫庆阳金学磊石翊飒王亚琴马玉英

英文作者：Yan Qingyang Jin Xuelei Shi Yisa Wang Yaqin Ma Yuying

单位：兰州大学第二医院麻醉科，兰州730030

英文单位：Department of Anesthesiology the Second Hospital of Lanzhou University Lanzhou 730030 China

关键词：罗哌卡因；纳洛酮；胸腰筋膜平面阻滞；术后镇痛

英文关键词：Ropivacaine;Naloxone;Thoracolumbarinterfascialplaneblock;Postoperativeanalgesia

• 摘要：

• 目的 探讨罗哌卡因联合低剂量纳洛酮胸腰筋膜平面（TLIP）阻滞用于腰椎融合术后镇痛的效果。方法 选取2022年4—8月于兰州大学第二医院行全身麻醉下后正中入路腰椎融合术（1～3个节段）的患者60例。采用随机数字表法将患者分为罗哌卡因组（R组）和罗哌卡因联合低剂量纳洛酮组（RN组），各30例。2组患者均行超声引导下双侧TLIP阻滞，R组每侧注入0.375%罗哌卡因20 ml，RN组每侧注入0.375%罗哌卡因联合10 μg纳洛酮混合液20 ml。记录术后2、6、12、18、24、48 h静息和翻身时视觉模拟量表（VAS）评分，术后48 h内舒芬太尼用量、患者静脉自控镇痛（PCIA）有效按压次数，首次要求补救镇痛时间及地佐辛用量。观察并记录患者术后48 h内阿片类药物相关不良反应发生情况。结果  RN组术后18、24 h静息和翻身时VAS评分均低于R组，差异均有统计学意义（均P＜0.05）。RN组术后48 h内舒芬太尼用量及PCIA有效按压次数均少于R组［（77.0±14.0）μg比（85.4±11.3）μg、（6.5±2.9）次比（8.0±2.9）次］，首次要求补救镇痛时间长于R组，地佐辛用量少于R组，差异均有统计学意义（均P＜0.05）。Kaplan-Meier生存分析结果显示，RN组术后48 h内无需补救性镇痛比例高于R组（Log-rank P=0.002）。2组术后48 h内阿片类药物相关不良反应发生率比较差异均无统计学意义（均P＞0.05）。结论   罗哌卡因联合低剂量纳洛酮TLIP阻滞可有效减轻腰椎融合术后患者的疼痛，延长TLIP阻滞有效镇痛时间及术后首次要求补救镇痛时间，减少术后阿片类药物及补救性镇痛药的用量，且安全性较好。

• Objective  To investigate the effect of thoracolumbar interfascial plane (TLIP) block with ropivacaine combined with low-dose naloxone on analgesia after lumbar spinal fusion. Methods Totally 60 patients undergoing posterior median approach lumbar spinal fusion (1-3 segments) under general anesthesia were enrolled from the Second Hospital of Lanzhou University from April to August 2022. Patients were divided into the ropivacaine group (group R) and the ropivacaine combined with low-dose naloxone group (group RN), with 30 cases in each group. Ultrasound-guided bilateral TLIP blocks were performed in both groups. The group R was injected with 20 ml of 0.375% ropivacaine on each side, and the group RN was injected with 20 ml of a mixture of 0.375% ropivacaine combined with 10 μg naloxone on each side. The visual analog scale (VAS) scores at rest and during turning over at 2, 6, 12, 18, 24 and 48 h postoperatively were recorded. The dosage of sufentanil, the number of effective compressions on patient controlled intravenous analgesia (PCIA), the time of first request for remedial analgesia and the dosage of dezocine were recorded in the postoperative 48 h. The occurrences of opioid-related adverse reactions were recorded. ResultsVAS scores at rest and during turning over in the group RN were significantly lower than those in group R at 18 and 24 h postoperatively (all P<0.05). The dosage of sufentanil and the number of effective compressions on PCIA in the group RN were less than those in the group R within 48 h postoperatively ［（77.0±14.0）μg vs （85.4±11.3）μg,（6.5±2.9）times vs （8.0±2.9）times］, the time of first request for remedial analgesia in the group RN was longer than in the group R, and the dosage of dezocinein the group RN was less than that in group R (all P<0.05). Kaplan-Meier survival analysis showed that the proportion of patients without remedial analgesia in the group RN was higher than that in the group R within 48 h postoperatively (Log-rank P=0.002). There were no statistically significant differences in the incidences of opioid-related adverse reactions within 48 h postoperatively(all P>0.05). Conclusions TLIP block with ropivacaine combined with low-dose naloxone effectively reduces the pain of patients after lumbar spinal fusion, and prolongs the postoperative analgesia time of TLIP block and the time of first request for remedial analgesia postoperatively, and reduces the dosage of postoperative opioids and remedial analgesics, with good safety.