超声引导下腰方肌阻滞与腹横筋膜阻滞用于腹腔镜结直肠手术术后镇痛效果比较

Quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia after laparoscopic colorectal surgery

目的:比较超声引导下腰方肌阻滞(quadratus lumborum block, QLB)和腹橫筋膜阻滞(transversus abdominis plane block, TAPB)对腹腔镜结直肠手术术后镇痛效果的影响。方法:择期行腹腔镜结直肠手术的患者100例,采用计算机生成的随机对照表分为腰方肌阻滞组(Q组,46例)和腹橫筋膜阻滞组(T组,41例)。全身麻醉前,Q组接受双侧QLB,分别给予0.25%罗哌卡因20 ml,T组行双侧TAPB,分别给予0.25%罗哌卡因20 ml。记录患者术后2、12、24、72 h静息及活动时内脏痛VAS评分和切口痛VAS评分,记录术后24 h吗啡用量、自控镇痛首次推注时间、患者术后第一次排气时间、第一次排便时间、术后恶心呕吐发生率,记录患者术中瑞芬太尼药物用量、PACU时长,记录患者局部麻醉药中毒反应、穿刺部位感染、下肢无力或麻痹、内脏损伤等不良反应发生情况。术后1个月随访患者,记录最近1周患者的平均VAS疼痛评分。结果:87例患者完成试验。Q组术后24 h吗啡用量低于T组( P<0.05),自控镇痛首次推注时间长于T组( P<0.05),术后2、12、24 h静息和活动时内脏痛VAS评分低于T组( P<0.05),术后24 h静息时切口痛VAS评分低于T组( P<0.05),术后第一次排气时间、第一次排便时间早于T组( P<0.05)。其他指标差异无统计学意义( P>0.05)。 结论:与TAPB比较,QLB的术后镇痛时间更长,对于内脏痛的镇痛效果更佳,缩短术后患者排气及排便时间,具有促进腹腔镜结直肠手术术后恢复的效果。

Objective This study aims to compare the analgesic effects of the quadratus lumborum block(QLB)with the effects of transversus abdominis plane block(TAPB)after laparoscopic colorectal surgery.Methods One hundred patients undergoing laparoscopic cholecystectomy were allocated into two groups according to a random number table generated by computer:group Q(n=46)and group T(n=41).All patients in group Q or group T were received bilateral QLB or bilateral TAPB with 0.25%ropivacaine 20 ml on each side.Cumulative morphine dose in 24 h and the time of first requirement for morphine as well as intraoperative remifentanil consumption and duration of post-anesthesia care unit(PACU)were recorded.Pain(visceral and incisional,at rest and on movement)was assessed at 2,12,24 h,and 72 h after surgery.The time to first flatus passage and the time to first bowel movement also recorded.Adverse events during and after surgery were recorded including the incidence of postoperative nausea and vomiting,puncture site infection,abdominal organ injury,local anesthetic toxicity,hypokinesia of the lower extremity,and paresthesia.All patients were followed up for one month while the average Visual Analogue Scale(VAS)score in the last week was also recorded.Results Eighty-seven of one hundred patients fulfilled the study protocol.The cumulative morphine dose in the first 24 h in group Q was significantly lower than the dose in group T(P<0.05).The time of the first requirement for morphine was significantly longer in group Q than in the time group T.The VAS scores for postoperative visceral pain at rest and on movement in group Q were significantly lower than the scores in group T at 2,12 h and 24 h respectively(P<0.05).The VAS scores for postoperative incisional pain(at rest)were also low in group Q at 24 h.The time to first flatus passage and the time to first bowel movement of patients who received QLB were also significantly shorter in patients who received TAPB(P<0.05).There was no significant difference between the two groups in other outcomes(P>0.05).Conclusions Compared with the TAPB,QLB provided better visceral pain relief with a longer duration of effect and accelerated postoperative recovery of bowel function in patients under laparoscopic colorectal surgery.