Abstract:

Objective　To explore the anesthetic effect of dexmedetomidine combined with ropivacaine for erector spinae plane block (ESPB) in the surgery for lumbar disc herniation. Methods　A total of 100 patients with lumbar disc herniation who were admitted to Xi'an Daxing Hospital from January 2023 to May 2024 were selected as the study subjects. Using the odd-even random number table method, the patients were divided into the control group (50 cases) and the study group (50 cases). In the control group, there were 28 males and 22 females; age (47.25±5.63) years. In the study group, there were 31 males and 19 females; age (47.94±5.81) years. All patients underwent posterior lumbar bone graft fusion and internal fixation surgery. The control group received ropivacaine ESPB, while the study group received dexmedetomidine combined with ropivacaine ESPB. The stress indicators [cortisol (Cor), aldosterone (ALD)] were compared between the two groups before entering the operating room (T1), during incision (T2), at the end of the surgery (T3), and at extubation (T4); the number and dosage of intravenous analgesics used were compared between the two groups during the surgery and within 7 d after the surgery; the Visual Analogue Scale (VAS) scores of movement and rest status were compared between the two groups at 4 h, 8 h, 16 h, and 24 h after the surgery; the occurrence of adverse reactions (nausea and vomiting, dizziness/headache, hematoma at the puncture site, and nerve injury) were compared between the two groups within 72 h after the surgery. Independent sample t test, repeated measures analysis of variance, χ² test, and Fisher's exact probability method were used for statistical analysis. Results　At T1,There was no statistically significant difference in the levels of Cor and ALD between the two groups (both P>0.05). At T2, T3 and T4,the levels of Cor and ALD in the study group were all lower than those in the control group (all P<0.05). During the surgery and within 7 d after the surgery, the number and dosage of intravenous analgesics used in the study group were all lower than those in the control group [(10.62±1.69) times vs. (15.04±2.07) times, (542.25±65.26) mg vs. (783.29±94.45) mg; (11.63±1.37) times vs. (18.26±2.07) times, (584.27±72.57) mg vs. (904.48±105.38) mg] (all P<0.05). At 4 h, 8 h, 16 h and 24 h after the surgery, the VAS scores of the study group during both exercise and rest were lower than those of the control group [(2.05±0.64) points vs. (5.34±1.06) points, (1.93±0.54) points vs. (4.58±0.95) points, (1.63±0.42) points vs. (5.11±0.87) points, (3.13±0.49) points vs. (3.54±0.84) points; (1.40±0.58) points vs. (3.67±0.66) points, (1.53±0.47) points vs. (2.84±0.72) points, (1.03±0.27) points vs. (2.63±0.62) points, (1.60±0.43) points vs. (2.76±0.58) points] (all P<0.05). Within 72 h after the surgery, there was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusions　Dexmedetomidine combined with ropivacaine ESPB has a good anesthetic effect in lumbar disc herniation surgery, and the postoperative analgesic effect is significant. It can also improve the stress response and is worthy of promotion and application.

Key words: Lumbar disc herniation, Dexmedetomidine, Ropivacaine, Erector spinae plane block

摘要： 目的　探讨右美托咪定复合罗哌卡因竖脊肌平面阻滞（ESPB）在腰椎间盘突出症手术中的麻醉效果。方法　选取2023年1月至2024年5月西安大兴医院收治的100例腰椎间盘突出症患者作为研究对象。采用单双数随机数字表法，将患者分为对照组（50例）与研究组（50例）。对照组男28例，女22例；年龄（47.25±5.63）岁。研究组男31例，女19例；年龄（47.94±5.81）岁。所有患者均行腰椎后路植骨融合内固定术。对照组接受罗哌卡因ESPB，研究组接受右美托咪定复合罗哌卡因ESPB。比较两组于进入手术室前（T1）、切皮时（T2）、手术完成时（T3）、拔管时（T4）的应激指标［皮质醇（Cor）、醛固酮（ALD）］；比较两组术中及术后7 d内静脉镇痛药使用次数及剂量；比较两组术后4 h、8 h、16 h、24 h运动及静息状态视觉模拟量表（VAS）评分；比较两组术后72 h内不良反应发生情况（恶心呕吐、头晕/头痛、穿刺部位血肿及神经损伤）。采用独立样本t检验、重复测量方差分析、χ²检验和Fisher确切概率法进行统计学分析。结果　T1，两组Cor、ALD水平比较，差异均无统计学意义（均P>0.05）。T2、T3、T4，研究组Cor、ALD水平均低于对照组（均P<0.05）。术中及术后7 d内，研究组静脉镇痛药使用次数及剂量均低于对照组［（10.62±1.69）次比（15.04±2.07）次、（542.25±65.26）mg比（783.29±94.45）mg；（11.63±1.37）次比（18.26±2.07）次、（584.27±72.57）mg比（904.48±105.38）mg］（均P<0.05）。术后4 h、8 h、16 h、24 h，研究组运动及静息状态VAS评分均低于对照组［（2.05±0.64）分比（5.34±1.06）分、（1.93±0.54）分比（4.58±0.95）分、（1.63±0.42）分比（5.11±0.87）分、（3.13±0.49）分比（3.54±0.84）分；（1.40±0.58）分比（3.67±0.66）分、（1.53±0.47）分比（2.84±0.72）分、（1.03±0.27）分比（2.63±0.62）分、（1.60±0.43）分比（2.76±0.58）分］（均P<0.05）。术后72 h内，两组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　右美托咪定复合罗哌卡因ESPB在腰椎间盘突出症手术中具有良好麻醉效果，术后镇痛效果显著，并能改善应激反应，值得推广应用。

关键词: 腰椎间盘突出症, 右美托咪定, 罗哌卡因, 竖脊肌平面阻滞