超声引导腰方肌阻滞用于剖宫产产妇术后镇痛的效果

Efficiency of ultrasound-guided quadratus lumborum block for postoperative analgesia in puerperants underwent Cesarean section

目的观察超声引导腰方肌阻滞用于剖宫产产妇术后镇痛的效果。方法 60例择期于椎管内麻醉下行剖宫产的患者随机均分为两组,分别于术毕行超声引导双侧腰方肌阻滞(Q组)和腹横肌平面阻滞(T组),每侧注入0.25%罗哌卡因30 ml并测定温觉阻滞平面。两组均行患者自控静脉镇痛,维持VAS疼痛评分≤3分。记录手术时间;于术后2、4、6、12、24、48 h行Bruggrmann舒适度评分(BCS评分)及Ramsay镇静评分;记录术后24 h内舒芬太尼总用量、有效/实际按压次数比(D1/D2)及不良反应发生情况。结果 Q组麻醉阻滞平面为T6~L1,T组为T10~L1。与T组比较,Q组术后24 h内舒芬太尼总用量减少,术后各时间点BCS评分和D1/D2升高(P<0.05)。两组Ramsay镇静评分无统计学差异(P>0.05),均未见明显不良反应。结论与超声引导腹横肌平面阻滞相比,腰方肌阻滞可减少剖宫产术后阿片类药物用量,镇痛效果更佳,且无严重并发症。

Objective To observe the efficiency of ultrasound-guided quadratus lumborum block for postoperative analgesia in the puerperants underwent Cesarean section.Methods Sixty puerperants scheduled for Cesarean section under intrathecal anesthesia were randomly and equally divided into two groups.After operation,ultrasound-guided bilateral quadratus lumborum block(group Q) and tansversus abdominis plane block(group T) were performed with 30 ml of 0.25% ropivacaine injected on each side. The operation time and the thalposis block plane were recorded.Both groups received intravenous patient-controlled analgesia(PCA) after Cesarean section,maintaining VAS pain score less than 3 points.Bruggrmann comfort scale(BCS) and Ramsay sedation scores were evaluated at 2,4,6,12,24 and 48 hours after operation.The consumption of sufentanil and the ratio of effective pressing times to actual pressing times of analgesic pump(D1/D2) within 24 hours after operation were calculated.The adverse responses such as nausea and vomiting were recorded as well.Results The anesthesia block plane was T6-L1 in group Q and T10-L1 in group T.Compared to group T,group Q had less consumption of sufentanil within 24 hours after operation and higher BCS score at each time point and the ratio of D1/D2(P<0.05).There was no significant difference in Ramsay sedation score between two groups(P>0.05).No adverse response occured in two groups.Conclusion Compared with tansversus abdominis plane block,ultrasound-guided quadratus lumborum block may provide better postoperative analgesia and reduce the consumption of opioids without serious adverse responses in the puerperants underwent Cesarean section.