超声引导下外侧弓状韧带腰方肌阻滞对腹腔镜肾脏手术患者术后疼痛和恢复质量的影响

Effect of Ultrasound-guided Quadratus Lumborum Block of Lateral Arcuate Ligament on Postoperative Pain and Quality of Recovery after Laparoscopic Renal Surgery

目的探讨超声引导下外侧弓状韧带腰方肌阻滞(quadratus lumborum block,QLB)对行腹腔镜肾脏手术(laparoscopic renal surgery,LRS)的患者术后疼痛和恢复质量的影响。方法本研究是一项前瞻性、随机对照试验,所有接受LRS的患者按照1∶1随机分配为外侧弓状韧带腰方肌阻滞组(QLB组)和对照组(C组),每组30例。QLB组全身麻醉诱导前行外侧弓状韧带腰方肌阻滞,C组不行神经阻滞,两组术后均应用静脉镇痛泵。记录两组患者术后2、6、12、24、48h的静息、运动的NRS评分;记录两组患者术前1天、术后第1天、3天15项恢复质量评分、术中静脉麻醉药用量、术后各时间点镇痛泵按压次数、阿片药物使用量、不良反应等。结果与C组比较,QLB组术后2、6、12、24h的静息、运动NRS评分及术后48h运动NRS评分明显小于C组(P<0.01);QLB组术后1天及3天恢复质量评分明显大于C组(P<0.01);QLB组术中瑞芬太尼用量较C组明显减少(P<0.05);QLB组患者术后24h、48h舒芬太尼用量、48h自控镇痛次数均小于C组(P<0.01);QLB组患者术后48h补救性镇痛例数,术后恶心、呕吐发生率小于C组,但差异无统计学意义(P>0.05)。结论超声引导下外侧弓状韧带腰方肌阻滞复合静脉镇痛泵可以为LRS提供良好的术后镇痛,促进患者术后早期恢复。

Objective To investigate the effect of ultrasound-guided quadratus lumborum block of lateral arcuate ligament(QLB)on postoperative pain and recovery quality in patients undergoing laparoscopic renal surgery(LRS).Methods This was a prospective,randomized controlled trial.All patients undergoing LRS were randomly divided into lateral arcuate ligament quadratus lumborum block group(QLB group,n=30)and control group(group C,n=30)at 1∶1.Patients in QLB group received superior quadratus lumborum block before general anesthesia,while patients in group C did not receive block.Intravenous analgesia pump was used for postoperative analgesia.The NRS scores of rest and movement at 2,6,12,24 and 48 hours after operation,the recovery quality score(QoR-15),intraoperative intravenous anesthetic dosage,postoperative analgesia pump pressing times,opioid dosage,adverse reactions and hospitalization were recorded.SPSS19.0 statistical software was used for data analysis.Results The resting and movement NRS scores at 2,6,12 and 24 hours after operation and the movement NRS score at 48 hours after operation in group QLB were significantly lower than those in group C(P<0.01).The recovery quality score of QLB group was significantly higher than that of group C at 1 day and 3 days after operation,and the intraoperative remifentanil dosage of QLB group was significantly lower than that of group C(P<005).The postoperative dose of sufentanil at 24 hours and 48 hours and patient-controlled analgesia times at 48 hours in group QLB were lower than those in group C(P<0.01).The incidence of postoperative nausea and vomiting in group QLB was lower than that in group C,but there was no significant difference between the two groups(P>0.05).Conclusion Ultrasound-guided quadratus lumborum block of lateral arcuate ligament combined with intravenous analgesia pump can provide good postoperative analgesia for LRS and promote the early recovery of patients after operation.