Zhang Li,Wang Junlu,Gu Zhiqing,et al.Application of accelerated rehabilitation surgical management plus erector spinal plane block during postoperative analgesia of children with tethered spinal cord[J].Journal of Clinical Pediatric Surgery,,22():1065-1071.[doi:10.3760/cma.j.cn101785-202304029-012]
Application of accelerated rehabilitation surgical management plus erector spinal plane block during postoperative analgesia of children with tethered spinal cord
- Keywords:
- Accelerated Rehabilitation Surgery; Erector Spinal Plane Block Anesthesia; Child; Tethered Cord; Analgesic Management
- Abstract:
- Objective To explore the clinical efficacy of enhanced recovery after surgery (ERAS) plus erector spinae plane block (ESPB) for post-untethering analgesia in children.Methods The relevant clinical data were retrospectively reviewed for 79 children with tethered cord syndrome (TCS) from January 2020 to November 2022.A total of 40 cases were in conventional administration group from January 2020 to March 2021 and 39 cases in ERAS+ESPB group from April 2021 to November 2022.Pain degrees,function outcomes and complication rates of two groups were compared within 3 days post-operation.Results Significant inter-group differences existed in pain scores at 24/48/72 h post-operation (F=24.261,P＜0.001).Pain scores of conventional and ERAS+ESPB groups were statistically significant (F=176.080,P＜0.001).Interaction between time factor and group was statistically significant (F=9.566,P＜0.001).Further analysis of separate effects of postoperative analgesic management at different monitoring timepoints and groups revealed no statistically significant difference in pain scores between 24 h and 48 h post-operation in conventional group (P=0.180) and pain scores declined significantly at 72 h versus 24/48 h post-operation (P＜0.001).Pain scores at Day 3 post-operation decreased obviously with the elapsing of time in ERAS+ESPB group (P＜0.001).Pain scores were significantly lower in ERAS+ESPB group than those in conventional group at 24/48/72 h post-operation (P＜0.001).Regarding postoperative function outcomes,length of hospital stay dropped in ERAS+ESPB group compared with conventional group [(9.23±1.13) vs.(13.85±2.9) day,t=4.683,P=0.022],frequency of postoperative analgesic pump compression declined greatly in ERAS+ESPB group versus conventional group[(5.67±1.94) vs.(9.18±2.65),t=3.818,P=0.031].Start time of postoperative functional exercise of lower extremity was significantly shorter in ERAS+ESPB group than that in conventional group [(4.62±0.66) vs.(7.75±0.54) day,t=8.689,P=0.006].No inter-group difference existed in catheter removal time [(6.66±0.84) vs.(6.51±0.72) day,t=1.665,P=0.249].The incidence of postoperative complications was significantly lower in ERAS+ESPB group than that in conventional group [n=3(7.7%) vs.n=10(25%),χ2=4.302,P=0.038].Conclusions Implementing ERAS plus ESPB can effectively control early postoperative pain,accelerate function recovery,reduce complications,shorten hospital stay and improve quality-of-life in TCS children.
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Memo
收稿日期:2023-4-11。
基金项目:上海市科学技术委员会上海市2020年度科技创新行动计划医学创新研究专项项目(20Y11905800)
通讯作者:王君璐,Email:wangjunlu_@126.com