Effect of Ropivacaine combined with Nalbuphine in Erector Spinae Plane Block on postoperative analgesia in Lumbar trauma surgery

Abstract

Abstract Backgroud Erector spinae plane block (ESPB) has been gradually applied to postoperative analgesia in Thoracic, Abdominal, and Spinal Surgery. However, the action time of local anesthetics is limited. Nalbuphine was used as an adjuvant of Ropivacaine to observe the postoperative analgesic effects of ESPB after lumbar trauma surgery. Methods This is a single-center, prospective, randomized, double-blinded, controlled research. Patients aged between 18 and 65 years, with ASA physical status I to Ⅱ, and scheduled for an elective surgical procedure. Ultrasound-guided ESPB was performed with 0.375% ropivacaine in group R and 0.375% ropivacaine combined with 10 mg nalbuphine in group N (each side dose 20 mL). The primary outcome measure was the first postoperative remedy analgesia time. The secondary outcome measures of the study were NRS scores for rest and during movement at 4 hr, 6 hr, 8 hr, 10 hr, 12 hr, 24 hr and 48 hr after extubation, accumulated consumption dose of sufentanil at 0–4 hr, 4–8 hr, 8–12 hr, 12–24 hr and 0–24 hr after surgery, intraoperative dosage of remifentanil and sufentanil, first off-bed time, first exhaust time and length of hospital stay. Results A total of 57 participants completed the study. The mean difference of the first postoperative remedy analgesia time(group N vs group R, 489 ± 52 min vs 391 ± 23 min) was 98 min (95%CI, 76 to 119). Kaplan Meier survival analysis showed increasing pain-free population in group N and pain-free time Log-rank (Mantel Cox) test showed the hazard ratio (HR, group N/group R) was 0.225 (95% CI, 0.114 to 0.443). NRS scores at rest at 8 hr, 10 hr and 12 hr after surgery in group N were significantly lower than those in group R(P < 0.05). NRS scores during movement at 8 hr and 10 hr after surgery in group N were significantly lower than those in group R(P < 0.05). Compared with group R, the cumulative consumption dose of sufentanil in group N at 4–8 hr, 8–12 hr and 0–24 hr after surgery was significantly reduced (P < 0.001). There was no statistically significant difference in postoperative complications, first off-bed time, first exhaust time, length of hospital stay and satisfaction situation between the two groups. Conclusion Compared with ropivacaine alone, the application of ropivacaine combined with nalbuphine for ESPB in posterior lumbar surgery can prolong the postoperative pain relief time significantly and reduce the patient's demand for analgesics.