Evaluation of the application of general anesthesia with tracheal intubation combined with quadratus lumborum block in lumbar spine surgery

Abstract

Objective To evaluate the clinical application of general anesthesia with tracheal intubation combined with quadratus lumborum block (QLB) in lumbar spine surgery. Methods Fifty patients with American Society of Anesthesiologists (ASA) Ⅰ‒Ⅲ who were scheduled for lumbar spine surgery were divided into two groups according to the random number table method (n=25): a control group (group C) and a QLB (group N). Before the induction of general anesthesia, patients in group N received bilateral QLB under the guidance of ultrasound, and were injected with 15 ml of 0.5% ropivacaine hydrochloride between the quadratus lumborum and psoas major muscle on each side. Group C did not undergo QLB, but completed operation under general anesthesia with tracheal intubation. The mean blood pressure (MAP), heart rate, pulse oxygen saturation (SpO2) were recorded before surgery (T0), immediately after anesthesia induction with endotracheal intubation (T1), before the starting of surgery (T2), at the end of surgery (T3), and immediately after extubation (T4). The operation time, blood loss, fluid intake and the score of surgeon’s satisfaction towards muscle relaxation were recorded. The Visual Analogue Scale (VAS) scores at resting were recorded at T4, 4 h after surgery (T5), 8 h after surgery (T6), 12 h after surgery (T7), 24 h after surgery (T8) and 48 h after surgery (T9). The VAS scores during movement were recorded from T7 to T9. The perioperative doses of propofol, remifentanil and cisatracurium besylate were recorded. The dose of sufentanil within 24 h after surgery, the pressing times of patient-controlled intravenous analgesia (PCIA) and the number of additional use of intravenous anesthetics for remediation were recorded. Postoperative complications such as nausea, vomiting and respiratory depression were recorded. Results There was no statistical difference in general information between the two groups (P>0.05). The VAS score of group N was lower than that of group C at each time point (P<0.05). The doses of propofol, remifentanil, cisatracurium besylate and sufentanil used in group N were significantly lower than those in group C (P<0.05). The number of postoperative analgesic remediation cases and the incidence of adverse reactions in group N were significantly lower than those in group C (P<0.05). Meanwhile, the surgeons presented better muscle relaxation satisfaction towards group N than group C (P<0.05). Conclusions The application of general anesthesia with tracheal intubation combined with QLB in patients for lumbar spine surgery can reduce the doses of general anesthetics, decrease the incidence of adverse reactions, and decline the VAS score after surgery, which is a feasible method of anesthesia. Key words: Lumbar spine surgery; Anesthesia, general; Quadratus lumborum block; Postoperative analgesia