超声引导下腰方肌阻滞与腹横肌平面阻滞技术在腹股沟疝修补术后镇痛中的应用比较

Comparison of the postoperative analgesic effects of ultrasound-guided quadratus lumborum block and transversus abdominis plane block after inguinal hernia repair

目的比较腰方肌阻滞与腹横肌平面阻滞在腹股沟疝修补术的术后镇痛效果。方法本研究为自身配对、左右对照、双盲研究。选择择期行双侧腹股沟疝修补术患者42例,均为男性,年龄60~80岁,体质量指数21~26kg/m^(2),美国麻醉医师协会Ⅰ~Ⅲ级。根据随机数字表分为腰方肌阻滞组(Q组)和腹横肌平面阻滞组(T组)。随机序列数为奇数的患者左侧为腰方肌阻滞组(Q组),右侧为腹横肌平面阻滞组(T组);偶数者右侧为Q组,左侧为T组。Q组行腰方肌阻滞,T组行腹横肌平面阻滞,均给予0.375%罗哌卡因20 ml。所有患者采用相同的全身麻醉方案。记录所有患者的拔管时间、术后2、4、8、12、24、48 h静息和活动时视觉模拟评估法(VAS)评分,补救镇痛使用情况,双侧神经阻滞持续时间。记录血肿、内脏损伤、局部麻醉药中毒、穿刺部位感染等神经阻滞穿刺并发症和恶心呕吐等不良反应发生情况。结果与T组比较,Q组患者术后12、24、48 h静息和活动时VAS评分均明显降低(P<0.05),神经阻滞持续时间明显延长(P<0.05)。术后24 h、48 h分别有11例(26.2%)和13例(31.0%)患者需补救镇痛。所有患者均未见血肿、内脏损伤、局部麻醉药中毒、穿刺部位感染等神经阻滞穿刺后并发症,6例(14.3%)患者出现术后恶心呕吐。结论Q组可安全应用于腹股沟疝修补术患者,较T组提供更长,术后镇痛效果更好。

Objective To compare the postoperative analgesic effects of quadratus lumborum block and transversus abdominis plane block in patients undergoing inguinal hernia repair.Methods This is a self-matched,left-right control,double-blind study.Forty-two male patients,aged 60 to 80 years,with BMI of 21 to 26 kg/m^(2),ASA physical status ofⅠtoⅢ,undergoing elective bilateral inguinal hernia repair were enrolled in this study.According to the random number table,they were divided into two groups:quadratus lumborum block group(group Q)and transversus abdominis plane block group(group T).The left side was group Q and the right side was group T when the random number was odd number.Conversely,the left side was group T and the right side was group Q when the random number was even number.Group Q received quadratus lumborum block while group T received transversus abdominis plane block.All the patients were given 20 ml of 0.375%ropivacaine under either of these two nerve blocks.All the patients received the same general anesthesia.The extubation time,visual analogue scale(VAS)at rest and on movement at 2,4,8,12,24,and 48 hours postoperative,the use of rescue analgesia,the duration of bilateral nerve block were recorded.We also recorded,complications of nerve block such as hematoma,visceral injury,local anesthetic poisoning,infection of puncture site and the incidences of adverse effects such as nausea and vomiting.Results The VAS scores at rest and on movement in group Q post-operative 12,24,48 h were lower than those in group T(P<0.05).The durations of analgesia were longer in group Q than that in group T(P<0.05).Eleven patients(26.2%)and thirteen patients(31.0%)needed rescue analgesia 24 and 48 h after operation respectively.No complications of nerve block such as hematoma,visceral injury,local anesthetic intoxication,and infection of puncture site were observed in both groups.Six patients(14.3%)suffered from nausea and vomiting after surgery.Conclusion The results of this study showed that in patients undergoing inguinal hernia repair,the quadratus lumborum block provided safe,longer and more effective postoperative analgesia compared with the transversus abdominis plane block.