超声引导下弓状韧带上腰方肌阻滞用于腹腔镜胆囊切除术的镇痛效果

Analgesic effect of ultrasound-guided quadratus lumborum block of arcuate ligament for laparoscopic cholecystectomy

目的评价超声引导下弓状韧带上腰方肌阻滞用于腹腔镜胆囊切除术的镇痛效果。方法选取潮州市中心医院2020年9~12月拟行腹腔镜胆囊切除术的60例患者为研究对象,按照随机数表法分为观察组和对照组,每组30例。观察组患者先采用超声引导下双侧弓状韧带上腰方肌阻滞镇痛,再予全麻下手术,而对照组患者则先采用全麻下手术,术毕再予切口局部浸润麻醉镇痛。比较两组患者术中和术后的镇痛效果、术中阿片类镇痛药维持剂量、术后清醒时间、清醒后疼痛视觉模拟评分(VAS)、术后48 h内注射镇痛药剂量,以及术后住院时间。结果观察组患者的术中阿片类镇痛药维持剂量为(0.19±0.02)μg/(kg·min),明显少于对照组的(0.33±0.05)μg/(kg·min),差异有统计学意义(P<0.05);观察组患者的术后清醒时间为(4.73±0.81)min,明显短于对照组的(9.82±1.66)min,差异有统计学意义(P<0.05);观察组患者的术后48 h内注射镇痛药剂量为(65.28±14.15)mg,明显少于对照组的(178.44±42.36)mg,差异有统计学意义(P<0.05);观察组患者清醒后的VAS评分为(2.13±0.42)分,明显低于对照组的(3.47±0.68)分,差异有统计学意义(P<0.05);观察组患者的术后住院时间为(2.98±0.72)d,明显短于对照组的(4.53±1.06)d,差异有统计学意义(P<0.05)。结论超声引导下弓状韧带上腰方肌阻滞用于腹腔镜胆囊切除术,术中镇痛效果确切,术后镇痛持续时间长,术后住院天数减少,完全符合快速康复的理念。

Objective To evaluate the analgesic effect of ultrasound-guided quadratus lumborum block of arcuate ligament for laparoscopic cholecystectomy.Methods A total of 60 patients scheduled for laparoscopic cholecystectomy in Chaozhou Central Hospital from September 2020 to December 2020 were selected as study subjects.According to the random number table,the patients were divided into an observation group and a control group,with 30 patients in each group.The patients in the observation group were first treated with ultrasound-guided quadratus lumborum block for analgesia,and then operated under general anesthesia,while the patients in the control group were first treated with general anesthesia,and then received local infiltration anesthesia of incision after the operation.The intraoperative and postoperative analgesic effects,intraoperative maintenance dose of opioid analgesics,postoperative wake-up time,the Visual Analogue Scale(VAS)score after awakening,the dose of analgesics injected within 48 hours after surgery,and the postoperative length of hospital stay were compared between the two groups.Results The intraoperative maintenance dose of opioid analgesics in the observation group was(0.19±0.02)μg/(kg·min),which was significantly less than(0.33±0.05)μg/(kg·min)of the control group(P<0.05);the postoperative wake-up time of patients in the observation group was(4.73±0.81)min,which was significantly shorter than(9.82±1.66)min in the control group(P<0.05);the dose of analgesics injected in the observation group within 48 hours after surgery was(65.28±14.15)mg,which was significantly less than(178.44±42.36)mg of the control group(P<0.05);the VAS score of the observation group after awakening was(2.13±0.42)points,which was significantly lower than(3.47±0.68)points of the control group(P<0.05);the postoperative length of hospital stay of the observation group was(2.98±0.72)days,which was significantly shorter than(4.53±1.06)days of the control group(P<0.05).Conclusion Ultrasound-guided quadratus lumborum block of arcuate ligament for laparoscopic cholecystectomy has definite analgesic effect during operation,long postoperative analgesia duration,and reduced postoperative hospital stay,which is completely in conformity with the concept of rapid rehabilitation.