腰方肌阻滞在剖宫产术后镇痛的效果评估

Ultrasound-guided qadratus lumborum block versus local infiltration for postoperative pain after lower segmental Cesarean section

目的比较超声引导腰方肌阻滞与切口局部浸润麻醉对子宫下段剖宫产术后镇痛的效果。方法采用随机、单盲、对照实验,选择择期行子宫下段剖宫产术患者88例,随机分成实验组(QLⅡ)和对照组(LI组)。QLⅡ组患者术后30 min内行超声引导腰方肌阻滞(QLⅡ阻滞);LI组术毕进行切口局部浸润麻醉。观察两组患者术后24、48 h舒芬太尼消耗量和无效按压PCA次数;术后6、12、24、48 h的静息状态和运动状态VAS评分;记录术后不良反应和患者满意度。结果 QLⅡ组与LI组相比较,术后48 h内舒芬太尼消耗量和无效按压PCA次数明显减少(P<0.05),术后24～48 h静息状态和运动状态VAS评分降低,患者满意度较高,其他不良反应无显著差异(P>0.05)。结论超声引导腰方肌阻滞应用于子宫下段剖宫产术能减少术后舒芬太尼的消耗量,获得更长时间镇痛(术后48 h),并且患者满意度更高。

Objective To investigate the efficacy of ultrasound-guided quadratus lumborum block applied to local infiltration for postoperative analgesia after lower segmental cesarean section.Methods A randomized,single-blind controlled trial was performed.Eighty-eight patients scheduled for cesarean delivery were randomLy divided into a study group(QLⅡgroup)and a control group(LI group):ultrasound-guided quadratus lumborum block(QLⅡapproach)was performed within 30 min after operation for QLⅡgroup.The patients in LI group received local infiltration anesthesia for surgical incision,respectively.The consumption of sufentanil,the visual analogue scale(VAS)on postoperative rest pain and activity pain,and the non-effective demands of PCA were evaluated during 48 h at different time;the adverse effects and the satisfaction of patients were also recorded.Results As compared with LI group,the consumption of sufentanil and VAS score were significantly decreased during 48 h after operation(P<0.05).There were significant differences in rest pain and activity pain at 24 and 48 hours;and a higher rate of patient satisfaction were observed in QLⅡgroup,There was no significant differ-ence in other adverse reactions(P>0.05).Conclusions Ultrasound-guided quadratus lumborum block is more ef-fective in reducing sufentanil consumption and has longer analgesia(48 h)and better patient satisfaction in pa-tients undergoing lower segmental Cesarean section.