腰方肌与腹横肌平面阻滞在妇科腹腔镜术后的镇痛效果比较

Comparison of ultrasound-guided quadratus lumborum block and transversus abdominis plane block for postoperative analgesia after gynecological laparoscopy

目的比较腰方肌阻滞(QLB)和腹横肌平面阻滞(TAPB)用于妇科腹腔镜手术患者术后镇痛的效果。方法选取于2016年1月~2017年6月在重庆市人口和计划生育科学技术研究院接受妇科腹腔镜手术的患者127例,ASAⅠ或Ⅱ级,随机分为QLB组(n=64)和TAPB组(n=63)。术后在超声引导下分别行双侧QLB或TAPB,在双侧腰方肌后表面或腹内斜肌和腹横肌之间给予0.375%的罗哌卡因40 mL,两组均行术后镇痛。观察并记录两组患者首次按压镇痛泵的时间,术后首次下床活动时间,术后4、8、12、24和48 h患者的疼痛VAS评分,BCS舒适度评分,术后48 h内舒芬太尼的消耗量;记录术后恶心呕吐、眩晕、皮肤瘙痒等不良反应的发生情况。结果两组患者均未观察到QLB和TAPB相关并发症。QLB组患者术后首次按压镇痛泵的时间明显长于TAPB组(P<0.05),首次下床活动时间明显早于TAPB组(P<0.05);与TAPB组比较,QLB组术后8、12、24 h的VAS评分降低,BCS评分升高(P<0.05);术后0~12 h、12~24 h、24~36 h QLB组舒芬太尼消耗量明显小于TAPB组(P<0.05)。QLB组术后过度镇静、恶心呕吐、眩晕的发生率明显低于TAPB组。结论QLB较TAPB能够更有效地为妇科腔镜手术患者提供理想的术后多模式镇痛效果,并且可以减少术后阿片类药物用量及不良反应的发生,有利于促进患者康复。

Objective To comparison the effects of ultrasound-guided quadratus lumborum block and transversus abdominis plane block for postoperative analgesia after gynecological laparoscopy.Methods 127 ASAⅠorⅡpatients underwent gynecological laparoscopic surgery in Chongqing Institute of Population and Family Planning Science and Technology from January 2016 to June 2017 were randomly divided into QLB group(n=64)and TAPB group(n=63).Both groups received postoperative analgesia.The time of first pressing analgesia pump,the time of first getting out of bed after operation,VAS score of pain,BCS comfort score and consumption of sufentanil within 48 hours after operation were observed and recorded.The incidence of adverse reactions such as nausea and vomiting,vertigo and skin pruritus were recorded.Results No complications related to QLB and TAPB were observed in both groups.Compared with TAPB group,the VAS score of QLB group was lower at 8,12 and 24 hours after operation,and the BCS score was higher at 0-12,12-24 and 24-36 hours after operation(P<0.05)The consumption of sufentanil in QLB group was significantly lower than that in TAPB group(P<0.05).The incidence of excessive sedation,nausea,vomiting and vertigo in QLB group was significantly lower than that in TAPB group.Conclusion QLB is more effective than TAPB in providing ideal multimodal postoperative analgesia for patients undergoing gynecological endoscopic surgery,and can reduce the dosage of opioids and the occurrence of adverse reactions,which is conducive to promoting the rehabilitation of patients.