Effect of ultrasound-guided bilateral posterior laminar block on postoperative analgesia and myocardial protection in patients with heart valve replacement under cardiopulmonary bypass
Objective To investigate the effect of ultrasound-guided bilateral retrolaminar block(RLB)on postoperative analgesia and myocardial protection in the patients with heart valve replacement under car-diopulmonary bypass(CPB).Methods A total of 70 patients with scheduled valve replacement under CPB in this hospital from May 2022 to March 2023 were selected as the study subjects and divided into the simple general anesthesia group(group A)and ultrasound-guided bilateral RLB combined general anesthesia group(group B)by the random number table method,35 cases in each group.There was no special treatment in the group A;before anesthesia induction,the group B underwent bilateral RLB under ultrasound guidance through the laminar level of the fourth thoracic vertebra.All patients used the patient-controlled intravenous analgesia(PCIA)pump after surgery.The mean arterial pressure(MAP)and heart rate(HR)of the two groups were recorded before anesthesia induction(T0),during intubation(T1),during sternal incision(T2),before CPB(T3),at 10 min after CPB stop(T4)and at 5 min after surgery(T5).The time of first awakening,extubation time and scores of the Numeric Pain Scale(NRS)in the resting and coughing states after extubation were re-corded in the two groups.The dose of intraoperative sufentanil and the oxycodone dose for remedy analgesia after extubation were recorded in the two groups.The levels of malondialdehyde(MDA),superoxide dis-mutase(SOD),cardiac troponin Ⅰ(cTnⅠ)and creatine kinase isoenzyme(CK-MB)were detected by ELISA at T0,30 min after CPB beginning(T6),30 min after CPB end(T7),postoperative 24 h(T8)and 48 h(T9).The occurrence situation of adverse events such as nausea and vomiting,puncture site infection,local anesthetic poisoning and puncture injury were recorded in the two groups.Results Compared with the group A,MAP and HR at T1,T2 and T3 in the group B were significantly decreased.The time of first awakening and extuba-tion after surgery were advanced.After extubation,the NRS score at rest and cough was significantly reduced;the dosage of sufentanil and oxycodone was reduced;the levels of MDA,cTnⅠ and CK-MB at T6,T7 and T8 were significantly decreased,the SOD level was significantly increased,and the differences were statistically significant(P＜0.05).There were no adverse events occurrence such as nausea and vomiting,puncture site in-fection,local anesthetic poisoning and puncture injury in both groups.Conclusion Ultrasound-guided bilateral RLB could stabilize the intraoperative hemodynamics and provide perfect analgesia in the patients with CPB heart valve replacement,meanwhile reduce the stress response and play certain role in myocardial protection.
万方数据
维普
