腰方肌与腹横肌平面阻滞在腹腔镜手术中的镇痛效果比较

Comparison of the analgesic effect between quadratus lumborum block and transversus abdominis plane block in laparoscopic operation

目的比较超声引导下腰方肌阻滞(QLB)与腹横肌平面阻滞(TAPB)在腹腔镜手术中的镇痛效果。方法选择2016年1月至2017年12月于郑州大学附属肿瘤医院拟行全身麻醉下腹腔镜手术患者160例,将患者分为QLB组(n=78)和TAPB组(n=82),2组患者分别于全身麻醉诱导前完成神经阻滞,超声引导下,QLB组患者于双侧腰方肌后表面各给予3.75 g·L^(-1)罗哌卡因20 mL,TAPB组患者于双侧腹内斜肌和腹直肌筋膜层各给予3.75 g·L^(-1)罗哌卡因20 mL。记录2组患者术中舒芬太尼用量、苏醒时间、拔除气管插管时间和术后曲马多镇痛次数;采用视觉模拟评分法(VAS)评估患者术后2、4、6、24、48 h镇痛效果,患者VAS评分>4分时给予曲马多镇痛。结果 QLB组患者术中舒芬太尼用量和术后镇痛次数显著少于TAPB组(P<0.05),且苏醒时间和拔管时间显著短于TAPB组(P<0.05)。术后2、4、6 h时,QLB组患者VAS评分显著低于TAPB组(P<0.05);2组患者术后24、48 h时VAS评分比较差异无统计学意义(P>0.05)。结论在全身麻醉腹腔镜手术中,超声引导下QLB的效果优于TAPB。

Objective To compare the analgesic effect between ultrasound guided quadratus lumborum block（QLB）and transversus abdominis plane block（TAPB） in laparoscopic operation.Methods A total of 160 patients undergoing laparoscopic surgery under general anesthesia in the Tumor Hospital Affiliated to Zhengzhou University from January 2016 to December 2017 were selected as the subjects.The patients were divided into QLB group（n=78） and TAPB group（n=82）.The nerve blocks of the patients in the two groups were completed before the induction of general anesthesia.The patients in QLB group were given 3.75 g·L-1 ropivacaine 20 mL on the posterior surface of bilateral quadratus lumborum under ultrasound guidance.The patients in TAPB group were given 3.75 g·L-1 ropivacaine 20 mL in the bilateral obliquus internus abdominis and fascia of rectus abdominis muscle respectively under ultrasound guidance.The sufentanil dosage,palinesthesia time,tracheal cannula removal time and the times of postoperative tramadol analgesia of the patients in the two groups were recorded.The analgesic effect was evaluated by Visual analogue scale（VAS） at the time points of 2,4,6,24 and 48 h after operation.The tramadol was used to relieve pain in patients with VAS score greater than 4.Results The sufentanil dosage and the times of postoperative analgesia in QLB group were significantly less than those in TAPB group（P〈0.05）.The palinesthesia time and extubation time in QLB group were significantly shorter than those in TAPB group（P〈0.05）.The VAS score in QLB group was significantly lower than that in TAPB group at the time points of 2,4 and 6 h after operation（P〈0.05）.There was no significant difference in VAS score between the two groups at the time points of 24 and 48 h after operation（P〈0.05）.Conclusion The effect of ultrasound guided QLB is better than TAPB in the laparoscopic operation under general anesthesia.