超声引导腰方肌阻滞对剖宫产术后镇痛效果的影响

Effect of ultrasound-guided quadratus lumborum block on efficacy of postoperative analgesia after caesarean section

目的 评价超声引导腰方肌阻滞对剖宫产术后镇痛效果的影响.方法 择期蛛网膜下腔阻滞下行剖宫产术产妇60例,年龄20～ 39岁,体重50～ 80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组（n=30）：腰方肌阻滞组（Q组）和对照组（C组）.Q组于术毕行超声引导双侧腰方肌阻滞,将药液注入腰方肌与腰大肌之间筋膜间隙内,每侧注射0.25％罗哌卡因1.25 mg/kg.术后均行静脉自控镇痛,维持VAS评分≤3分,若VAS评分≥4分,肌肉注射地佐辛5 mg补救镇痛.于术后2、4、6、12、24和48 h时行BCS舒适度评分和Ramsay镇静评分;记录术后24 h内PCIA中舒芬太尼用量、镇痛补救情况、镇痛满意度评分、有效按压次数（D1）和实际按压次数（D2）,计算D1/D2;记录镇痛期间呼吸抑制、镇静过度等的发生情况;记录腰方肌阻滞不良反应及术后恶心、呕吐、胸闷、皮肤瘙痒等的发生情况.结果 与C组比较,Q组BCS舒适度评分升高,舒芬太尼用量减少,D1/D2升高,镇痛补救率降低,镇痛满意度评分升高（P＜0.05）,Ramsay镇静评分差异无统计学意义（P＞0.05）.2组均未见呼吸抑制、镇静过度、恶心、呕吐、胸闷、皮肤瘙痒等不良反应发生.Q组术后未见穿刺部位血肿、感染、局麻药中毒等不良反应发生.结论 超声引导腰方肌阻滞可增强剖宫产术后镇痛效果,减少术后阿片类药物用量,提高产妇舒适度.

Objective To evaluate the effect of ultrasound-guided quadratus lumborum block （QLB） on the efficacy of postoperative analgesia after caesarean section.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients,aged 20-39 yr,weighing 50-80 kg,scheduled for elective cesarean section under subarachnoid block,were divided into 2 groups （n =30 each） using a random number table：QLB group （group Q） and control group （group C）.Ultrasound-guided bilateral QLBs were performed at the end of surgery,the solution was injected into the compartment between quadratus muscle and psoas major muscles,and 0.25% ropivacaine 1.25 mg/kg was injected to each side in group Q.The parturients in both groups received patient-controlled intravenous analgesia after surgery to maintain the visual analog scale score ≤ 3,and dezocine 5 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score≥4.Bruggrmann comfort scale （BCS） and Ramsay sedation scores were evaluated at 2,4,6,12,24 and 48 h after operation.The consumption of sufentanil during patient-controlled intravenous analgesia,requirement for rescue analgesia,satisfaction score of analgesia,the number of successfully delivered doses （D1） and the number of attempts （D2） were recorded within 24 h after surgery.D1/D2 was calculated.The development of respiratory depression and over-sedation was recorded.The development of QLB-related adverse reactions and postoperative nausea,vomiting,chest tightness and pruritus was also recorded.Results Compared with group C,BCS scores were significantly increased,the consumption of sufentanil was reduced,D1/D2 was increased,the requirement for rescue analgesia was decreased,and the satisfaction score of analgesia was increased （P〈0.05）,and no significant change was found in Ramsay sedation score in group Q （P〉0.05）.Adverse reactions such as respiratory depression,over-sedation,nausea,vomiting,chest tightness and pruritus were not found in two groups.Adverse reactions such as hematoma and infection at the puncture site or local anesthetic intoxication were not observed after surgery in group Q.Conclusion Ultrasound-guided QLB can enhance the efficacy of postoperative analgesia after caesarean section,reduce postoperative consumption of opioids and raise the comfort degree for parturients.