超声引导下腰方肌阻滞对剖宫产术后镇痛效果的影响

Effect of ultrasound-guided quadrate muscle block on analgesia after cesarean section

目的研究腰方肌阻滞(QLB)对剖宫产术后镇痛效果的影响。方法共纳入80例患者,随机分为QLB组和对照组。两组患者的一般情况(年龄、BMI、手术时长、麻醉时长)无明显差异(P>0.05)。QLB组双侧行Ⅱ型腰方肌阻滞,每侧给予0.375%罗哌卡因20ml后行腰硬联合麻醉,对照组患者麻醉前无特殊处理。观察术后2h,6h,12h,24h,48h静息时视觉模拟评分(VAS)、24h内的舒芬太尼消耗量、48h内静脉自控镇痛(PCIA)次数、首次PCIA时间和不良反应。结果QLB组患者在术后2h,6h,12h和24h的VAS评分显著低于对照组(P<0.05),术后24h内的舒芬太尼用量及PCIA次数少于对照组(P<0.05)。两组患者的术后不良反应(恶心、呕吐、瘙痒、低血压和肢体活动障碍)无明显差异(P>0.05)。结论腰方肌阻滞可缓解剖宫产患者的术后疼痛,减少术后阿片类药物的用量,提高患者满意度。

Objective To study the effect of lumbar block on analgesia after cesarean section.Methods A total of 80 patients were enrolled and randomly divided into QLB group and control group,there was no significant difference in general conditions(age,BMI,duration of operation,duration of anesthesia)between the two groups(P>0.05).In the QLB group,QL2 quadrat lumbago block was performed on both sides,and 20ml ropivacaine of 0.375%was given on each side before lumbar epidural anesthesia,while no special treatment was given to the patients in the control group before anesthesia.The outcome measures were VAS score at 2h,6h,12h,24h and 48h after surgery and sufentanil consumption within 24h,the first PCIA time,PCIA frequency within 48h and adverse reactions.Results VAS scores of QLB group at 2h,6 h,12h and 24h after surgery were significantly lower than those of the control group(P<0.05),sufentanil dose in QLB group was significantly lower than that in control group 24h after surgery(P<0.05).The time of PCIA in QLB group was longer than that in the control group(P<0.05),and the number of PCIA in QLB group was less than that in the control group(P<0.05).There was no significant difference in postoperative adverse reactions(nausea,vomiting,itching,hypotension and limb movement disorders)between the two groups(P<0.05).Conclusion Ultrasoundguided QLB can relieve postoperative pain of cesarean section patients,reduce postoperative opioid dosage and improve patient satisfaction.