Objective:To determinate the block range of lumbar erector spinal plane (ESPB), and investigate the efficacy of ESPB in lumbar spine surgery.Methods:Forty patients who underwent posterior lumbar fusion in the Second Affiliated Hospital of Wenzhou Medical University from November 2019 to August 2020 were randomly divided into two groups (with n=20 in each group) using the random number table: the experimental group (group E) and control group (group C). All the patients received ultrasound-guided bilateral ESPB with 20 ml of 0.375% ropivacaine (group E) or equal volume of normal saline (group C) on each side before induction of general anesthesia. The range of weakened temperature sense in each patient was measured at 10 min, 20 min and 30 min after ESPB, respectively. Dosage of analgesic drug, visual analog scale (VAS), and incidence of adverse events were recorded and compared between the two groups. Results:In group E, the dermatomal distribution and area of weakened temperature sense at 10 min, 20 min, 30 min after ESPB were T9-S1 (222±16) cm 2, T8-S2 (352±22) cm 2, T8-S3 (481±24) cm 2, respectively. The intraoperative dosage of remifentanil in group E was (0.76±0.02) mg, which was significantly lower than that of group C (0.97±0.06) mg ( P<0.05). Oxycodone consumption in group E at 0-12 h and 12-24 h after surgery was (4.9±0.4) mg and (8.4±1.2) mg, respectively, which were lower than those in group C [(14.5±2.4) mg and (19.3±2.4) mg, respectively] (both P<0.05). The VAS during rest and movement within 24 h after operation in group E were significantly lower than those in group C (both P<0.05). The passive exercise in bed in group E started at (3.3±0.3) h postoperatively, which was earlier than that in group C (4.6±0.3) h ( P<0.05). Conclusion:The blocking effects of T12-S1 segment after ultrasound-guided lumbar ESPB is definite, which can effectively decrease the amounts of analgesics during and after the lumbar fusion surgery, reduce postoperative rest and exercise VAS score, and contribute to a rapid recovery of the patients.

2020年国际疼痛研究协会(international association of the study for pain,IASP)将"疼痛"的定义修订为"疼痛是一种与实际或潜在的组织损伤相关的不愉快的感觉和情绪情感体验,或与此相似的经历"[1].目前国际上对疼痛的关注程度也越来越高.在美国仍有约66％的患者经历了中度以上术后疼痛[2].一项2020西班牙多中心横向调查发现73％的患者经历了术后急性疼痛[3].目前国内仍缺少由麻醉科医师主导的大范围术后疼痛情况数据.本研究调查患者术后急性疼痛的现状,为指导疼痛管理工作提供参考.

目的 采用超声观察婴幼儿颈部不同平面右侧颈内静脉横径大小并分析相关因素,观察其与颈部大动脉之间的毗邻关系.方法 选择择期手术的患儿90例,年龄6个月至3岁,ASAⅠ或Ⅱ级,在全麻诱导置入合适喉罩后使用七氟醚维持麻醉深度,并保留自主呼吸.患儿均为平卧位,头转向左侧约40°.使用超声分别在环状软骨平面、锁骨上平面及两个平面之间的中间平面观察右侧颈内静脉、颈总动脉和椎动脉的短轴成像,分别在三个平面测量颈内静脉、颈总动脉和椎动脉的血管横径;记录颈总动脉或椎动脉与颈内静脉之间相对方位;观察颈总动脉与颈内静脉、椎动脉与颈内静脉之间是否重叠,如有重叠则测量重叠程度;测量椎动脉(前壁)与颈内静脉(后壁)间的垂直深度.结果 颈内静脉横径在中间平面、锁骨上平面均明显大于环状软骨平面(P<0.05).在三个平面中,颈内静脉横径大小均与患儿月龄呈正相关,其位置均位于颈总动脉前方.相对于颈内静脉,颈总动脉随着平面的下移而越来越靠近内侧(P<0.05).颈内静脉与颈总动脉重叠程度在锁骨上平面明显低于其他平面(P<0.05).颈内静脉与椎动脉重叠程度在锁骨上平面明显大于环状软骨平面(P<0.05).椎动脉均位于颈内静脉深部,两者间在锁骨上平面的垂直深度最浅(P<0.05).结论在不同颈部水平,婴幼儿右颈内静脉与颈部大动脉的相对位置不同.在右颈内静脉高位穿刺应更加警惕颈总动脉损伤的风险,而在低位需警惕椎动脉损伤的风险,同时避免使用穿透颈内静脉后壁法.