超声引导下腰方肌后阻滞和连续硬膜外镇痛对剖宫产术后镇痛效果的比较

Comparison of the postoperative analgesia effects of ultrasound-guided quadratus lumborum block and patient-controlled epidural analgesia for caesarean section

目的 比较腰方肌阻滞(QLB)和连续硬膜外镇痛在剖宫产术后的镇痛效果。方法 前瞻性选取2019年4~10月首都医科大学附属北京友谊医院收治的行剖宫产的产妇60例,采用随机数字表法将其分为三组:腰方肌阻滞组(QLB组)、连续硬膜外镇痛组(PECA组)和腰方肌阻滞+连续硬膜外镇痛组(QLB+PCEA组),每组各20例。于剖宫产术后,给予PCEA组和QLB+PCEA组产妇连接硬膜外镇痛泵,镇痛泵配方为150 mg罗哌卡因、50μg舒芬太尼用生理盐水配至250 ml。给予QLB组和QLB+PCEA组产妇行超声引导下双侧腰方肌阻滞,采用腰方肌后阻滞,给予0.375%的罗哌卡因两侧各25 ml。记录以下指标:①三组产妇术后6 h、12 h、24 h、48 h产妇的静态疼痛VAS评分;②PCEA组和PCEA+QLB组产妇术后24 h、48 h内镇痛泵的按压次数和舒芬太尼用量;③PCEA组和QLB组产妇在镇痛期间不良反应发生情况。结果 QLB组和PCEA组产妇术后6 h、12 h、24 h、48 h静息时疼痛评分比较,差异均无统计学意义(P> 0. 05)。PCEA+QLB组产妇的术后6 h静态疼痛VAS评分(1. 75±0. 50分)、以及12 h静态疼痛VAS评分(1. 00±0. 0分)分别较PCEA组产妇术后6 h(3. 19±1. 11分)和12 h(2. 31±0. 79分)更低,差异具有统计学意义(P <0. 05);24 h、48 h的静息疼痛评分无显著差异;但24 h、48 h内的镇痛泵按压次数明显减少,PCEA组24 h(9. 79±8. 41次)、48 h(11. 68±9. 63次),PCEA+QLB组24 h(3. 11±2. 22次)、48 h(5. 96±4. 57次),差异均具有统计学意义(P <0. 05)。PCEA+QLB组产妇较PCEA组产妇,24 h内使用的舒芬太尼量差异无统计学意义(P> 0. 05);但48 h内使用的舒芬太尼量减少,PCEA组(46. 13±2. 42μg),PCEA+QLB组(9. 71±1. 48μg),差异具有统计学意义(P=0. 039)。QLB组产妇麻醉不良反应发生率为0,PCEA组为20. 0%,显著高于QLB组,差异具有统计学意义(P=0. 035)。结论与连续硬膜外镇痛相比,超声引导下腰方肌后阻滞用于剖宫产术后镇痛,可减少围手术期舒芬太尼用量和麻醉不良反应的发生。

Objective To compare the postoperative analgesia effects of quadratus lumborum block and patient-controlled epidural analgesia for caesarean section.Methods This was a prospective study enrolled 60 pregnant women who underwent caesarean section from April to October 2019 in Beijing Friendship Hospital,Capital Medical University.The parturients were randomly divided into three groups:quadratus lumborum block group(QLB),patient-controlled epidural analgesia group(PCEA),and patient-controlled epidural analgesia+quadratus lumborum block group(PCEA+QLB),20 cases in each group.Parturients in the QLB and PCEA+QLB group received ultrasound-guided bilateral QLB using 25 ml 0.375%Ropivacaine per side after surgery.While parturients in the PCEA and PCEA+QLB group received patient-controlled epidural analgesia(PCEA)after surgery using 150 mg Ropivacaine,50μg Sufentanil and 234 ml normal saline.The following indicators were recorded:①The resting VAS score at 6 h,12 h,24 h,48 h after caesarean section of all the parturients in three groups.②The sufentanil consumption and the times of compression of analgesic pump within 24 h,48 h after caesarean section in the PCEA group and the PCEA+QLB group.③Postoperative adverse reactions in the PCEA group and the QLB group.Results There were no significant differences in VAS score between the QLB group and the PCEA group at 6 h,12 h,24 h,and 48 h after surgery(P>0.05).In the PCEA+QLB group,the VAS score at 6h(1.75±0.50)and 12h(1.00±0.0)were respectively lower than those in the PCEA group(6 h(3.19±1.11)and 12 h(2.31±0.79 points),the differences were statistically significant(P<0.05);there was no difference in VAS score at 24 h and 48 h;but comparing of compression of analgesic pump,the PECA+QLB group was less than the PCEA group at 24 h(3.11±2.22 vs.9.79±8.41),and at 48 h(5.96±4.57 vs.11.68±9.63),(P<0.05).There was no difference in sufentanil consumption within 24 h between the PCEA group and the PCEA+QLB group,while within 48 h the PECA+QLB group(9.71±1.48μg)was significantly less than the PECA group(46.13±2.42μg)(P=0.039).The adverse reactions in the QLB group(0)were significantly less than those in the PCEA group(20.0%),(P=0.035).Conclusion The ultrasound-guided quadratus lumborum block can be used for postoperative analgesia after caesarean section.It can reduce the consumption of the Sufentanil and the incidence of adverse reactions.