目的 通过比较脂质体布比卡因(LB)与左布比卡因用于竖脊肌平面阻滞的效果,评价LB在腰椎融合术后早期镇痛的安全性及有效性,为临床低阿片镇痛诊疗提供依据.方法 选择择期行腰椎融合术患者60例.采用随机数字表法分为脂质体布比卡因组(LB组)和盐酸左布比卡因组(B组),每组30例.两组全麻后行竖脊肌阻滞,LB组局麻药为脂质体布比卡因20 mL(266 mg)+40 mL生理盐水.B组局麻药为盐酸左布比卡因20 mL(150 mg)+40 mL生理盐水.两组每侧均注入20 mL.记录患者PACU、术后6、24、48、72 h疼痛数字评分法(NRS)评分.记录围术期舒芬太尼用量.比较两组补救镇痛情况、镇痛泵按压次数及输入药液剂量.记录患者PACU停留时间、住院时间.记录患者术后不良反应情况.结果 LB组在PACU、术后 24、48、72 h 的运动 NRS 评分[1(1,2)、3(3,4)、3(2,3)、2(2,3)]显著低于 B 组[2(1,3)、4(4,4)、3(2.75,3)、3(2,3)](P＜0.05).两组患者不同时间静息NRS评分差异无统计学意义(P＞0.05).LB组术中、术后 24、48 h 舒芬太尼消耗量[(27.33±3.88)、(76.2±10.98)、(112.38±18.46)μg]均少于 B 组[(31.50±4.76)、(83.52±9.36)、(121.98±15.91)μg](P＜0.05).LB 组 24、48 h 内镇痛泵按压总次数、有效次数、镇痛泵药液输入量{ 24 h[0(0,1)、0(0,1)、(50.37±3.76)mL]、48 h[0(0,2)、0(0,2)、(87.53±8.72)mL]}均少于 B 组｛24 h[2(0,4)、2(0,4)、(53.60±4.62)mL]、48 h[3(1,6)、3(0,5)、(93.00±8.17)mL]}(P＜0.05).两组PACU停留时间、住院时间、不良反应差异无统计学意义(P＞0.05).结论 脂质体布比卡因可安全应用于腰椎融合术中,提供患者术后72 h镇痛并减少围术期阿片类药物消耗,利于患者早期恢复.
Erector spinae block with liposomal bupivacaine for analgesia in lumbar fusion surgery
Objective To compare the efficacy of liposomal bupivacaine(LB)and levobupivacaine in erector spinae plane block(ESPB)for lumbar fusion surgery and evaluate the safety and effectiveness of LB in early postoperative analgesia,providing evidence for clinical low-opioid analgesia strategies.Methods Sixty patients scheduled for elec-tive lumbar fusion surgery were randomized into two groups:the liposomal bupivacaine group(LB group,n=30)and the levobupivacaine group(B group,n=30).Both groups received ESPB after general anesthesia.The LB group received 20 mL liposomal bupivacaine(266 mg)+40 mL normal saline,while the B group received 20 mL levobupivacaine(150 mg)+40 mL normal saline,with 20 mL injected per side.Pain numeric rating scale(NRS)scores were recorded at PACU(post-anesthesia care unit),and at 6,24,48,and 72 hours postoperatively.Perioperative sufentanil consump-tion,rescue analgesia,patient-controlled analgesia(PC A)pump usage,and postoperative adverse events were also re-corded.Results The LB group exhibited significantly lower movement NRS scores at PACU,24,48,and 72 hours post-operatively[1(1,2)、3(3,4)、3(2,3)、2(2,3)]compared to the B group[2(1,3)、4(4,4)、3(2.75,3)、3(2,3)](P＜0.05).Resting NRS scores were not significantly different between the groups(P＞0.05).The LB group consumed less sufentanil intraoperatively and at 24 and 48 hours postoperatively[(27.33±3.88)μg,(76.2±10.98)µg,(112.38±18.46)μg]than the B group[(31.50±4.76)µg,(83.52±9.36)µg,(121.98±15.91)µg,P＜0.05].PCA pump parameters,including total presses,effective presses,and analgesic drug consumption at 24 and 48 hours,were significantly lower in the LB group compared to the B group(P＜0.05).There were no significant differences in PACU stay time,hospitalization duration,or adverse events between the two groups(P＞0.05).Conclusion Liposo-mal bupivacaine can be safely used in lumbar fusion surgery,providing effective analgesia for up to 72 hours postoperative-ly while reducing perioperative opioid consumption,thus promoting early recovery.
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