超声引导下腰方肌阻滞对肾移植术后镇痛效果的影响

Effect of ultrasound-guided quadratus lumborum block for postoperative analgesia in patients undergoing kidney transplantation

目的探讨超声引导下腰方肌阻滞(quadratus lumborum block,QLB)对肾移植受体手术患者术后镇痛效果的影响。方法选择拟行同种异体肾移植受体手术的终末期肾病患者50例,男女不限,年龄18~64岁,体重45~80 kg,ASA分级Ⅲ级。采用随机数字表法将患者分为2组(每组25例):QLB组和常规镇痛对照组(C组)。QLB组在全身麻醉诱导后行超声引导下手术侧QLB,注入0.375%罗哌卡因30 ml;C组不行QLB。两组术后均使用舒芬太尼行患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA),维持术后48 h内静息VAS评分≤3分。记录术后48 h内PCIA舒芬太尼总用量、有效按压次数及补救镇痛例数。记录术后2、4、6、12、24、48 h的静息VAS评分和Ramsay评分。记录术后48 h内恶心呕吐、皮肤瘙痒和呼吸抑制的发生情况,QLB组记录阻滞相关并发症的发生情况。结果与C组比较,QLB组术后48 h内PCIA舒芬太尼总用量降低、有效按压次数减少(P<0.05),两组补救镇痛例数差异无统计学意义(P>0.05)。两组在不同时点静息VAS评分和Ramsay评分差异无统计学意义(P>0.05)。两组术后恶心呕吐、皮肤瘙痒和呼吸抑制等发生率比较,差异无统计学意义(P>0.05),QLB组未见阻滞相关并发症发生。结论超声引导下QLB可以减少肾移植受体手术患者术后阿片类药物用量,方法安全、有效。

Objective This paper investigates the efficacy of ultrasound-guided quadratus lumborum block(QLB)for postoperative analgesia in patients undergoing renal transplantation.Methods Fifty end-stage renal disease patients,aged 18-64 years,weighing 45-80 kg,American Society of Anesthesiologists(ASA)Ⅲ,scheduled for kidney transplantation,were divided into 2 groups according to random number table method(n=25 each):group QLB and routine analgesia control group(group C).Ultrasound-guided QLB was performed on the side of operation with 0.375%ropivacaine 30 ml in group QLB after induction,while no block was performed in group C.All the patients received patient controlled intravenous analgesia(PCIA)with sufentanil after operation while Visual Analogue Scale(VAS)scores at rest were maintained equal or lesser than 3.The total sufentanil consumption,the effective pressing times of PCIA and number of patients requiring rescue analgesic medication within 48 h after surgery were recorded.VAS scores at rest and Ramsay scores were recorded at 2,4,6,12,24 and 48 h after surgery.The occurrence of nausea and vomiting,pruritus,respiratory depression within 48 h after operation as well as QLB-related complications in QLB group were recorded.Results Compared with group C,the total consumption of sufentanil and the effective pressing times of PCIA was decreased after surgery in group QLB(P<0.05).There was no significant difference in the times of requiring rescue analgesic medication between the two groups(P>0.05).There were no significant difference in VAS scores and Ramsay scores at different time points after surgery(P>0.05).Also,there was no significant difference in the incidence of postoperative nausea and vomiting,pruritus and respiratory depression between the two groups(P>0.05).QLB-related complications were not found in group QLB.Conclusions Ultrasound-guided QLB can not only provides safe analgesia without additional complications,but also reduce postoperative opioid consumption in renal transplant recipients.