To explore the clinical efficacy and safety of thoracolumbar fascia plane block with ropivacaine hydrochloride injection combined with compound betamethasone injection in elderly patients undergoing lumbar spine surgery during the perioperative period.

The elderly patients admitted to our hospital who underwent posterolateral approach lumbar fusion (PLIF) under general anesthesia due to lumbar degenerative diseases were divided into control group and treatment group according to different anesthesia methods. Both groups of patients received thoracolumbar fascia plane (TLIP) block. Control group was injected with a single dose of 20 mL of 0.375% ropivacaine hydrochloride injection, while treatment group was injected with a single dose of a mixture of 20 mL of 0.375% ropivacaine hydrochloride injection and 5 mg of compound betamethasone injection for TLIP block. The remaining operations were same. The hemodynamic indicators, rehabilitation process indicators, opioid dosage and remedial analgesia conditions, visual analogue scale (VAS) scores at rest and turning over at different time points, stress and immune indicators of the two groups of patients were compared, and safety evaluations were conducted.

A total of 115 cases were screened in this study, with 102 cases enrolled. Among them, 50 cases were enrolled in control group and 52 cases in treatment group. The heart rate (HR) of the control group and the treatment group at T₄ were (82.13±10.68) and (74.81±10.19) times·min^-1, respectively; and the mean arterial pressure (MAP) were (92.33±9.87) and (88.27±8.92) mmHg, respectively; the recovery time were (36.41±6.97) and (31.87±6.53) min, respectively; and the resting VAS scores at 48 hours after the operation were (2.71±0.88) and (2.56±0.82) points, respectively; the VAS scores at turning over 48 hours after the operation were (3.42±0.97) and (2.88±0.84) points, respectively; the first PCIA time were (20.04±5.67) and (16.79±4.32) hours, respectively; the effective compression times of PCIA were (14.19±4.36) and (11.64±3.52) times, respectively; and the β-Endorphin (β -endorphin) 24 hours after the operation were (160.31±19.68) and (146.83±18.49) pg·mL^-1, respectively; CC Chemokine ligand 2 (CCL2) were (109.39±19.78) and (97.86±17.88) pg·mL^-1, respectively; angiotensin Ⅱ (Ang Ⅱ) were (79.14±12.53) and (70.65±11.71) pg·mL^-1, respectively. The above indicators of treatment group were compared with those of control group, and the differences were all statistically significant (all P<0.05). The incidence rates of adverse reactions to anesthetic drugs during the perioperative period in the two groups of patients were 9.62%(5 cases/52 cases) and 16.00%(8 cases/50 cases), respectively, and there was no statistically significant difference (P>0.05).

The TLIP block with ropivacaine combined with betamethasone can enhance the analgesic effect during the perioperative period of patients undergoing PLIF, reduce the dosage of opioid drugs, alleviate early pain symptoms and the level of postoperative stress responses, and has a relatively high level of safety.