不同入路腰方肌阻滞在后腹腔镜肾癌根治术后镇痛中的应用效果:一项随机对照试验

Application effects of quadratus lumbar block with different approaches in analgesia after retroperitoneal laparoscopic radical nephrectomy:a randomized controlled trial

目的比较不同入路腰方肌阻滞(QLB)对后腹腔镜肾癌根治术后镇痛及早期康复的影响。方法选择择期行后腹腔镜肾癌根治术的65例患者为研究对象,采用随机数字法将其分为外侧入路组(n=32)和后路组(n=33)。两组患者均于术前按各自的入路方式行超声引导神经阻滞,均给予0.375%罗哌卡因20 mL,术毕给予PCIA镇痛治疗。比较两组患者的一般临床特征(年龄、身高、体重、BMI、性别、ASA分级情况),术后4、8、12、24、48 h的静息、活动VAS评分及镇痛节段数,术中指标(舒芬太尼用量、瑞芬太尼用量及手术时间)、术后镇痛指标(曲马多消耗量、术后48 h内静脉镇痛泵有效按压次数、首次补救镇痛需求时间、额外镇痛需求人数)、康复指标(术后首次下地活动时间、引流管拔出时间、肛门排气时间、尿管拔出时间及住院时间)及不良反应发生情况。结果术后24 h,后路组的活动VAS评分低于外侧入路组,镇痛节段数多于外侧入路组(P<0.05)。后路组曲马多消耗量、术后48 h内静脉镇痛泵有效按压次数少于外侧入路组,首次补救镇痛需求时间长于外侧入路组,额外镇痛需求人数占比低于外侧入路组(P<0.05)。结论后腹腔镜肾癌根治术后超声引导后路QLB镇痛效果优于外侧入路QLB,可以减少术后镇痛全身用药量,并延长首次补救镇痛需求时间。

Objective To compare the effects of different approaches of lumbar quadratus block(QLB)on analgesia and early rehabilitation after retroperitoneal laparoscopic radical nephrectomy.Methods A total of 65 patients undergoing elective retroperitoneal laparoscopic radical nephrectomy were selected as the study objects and divided into lateral approach group(n=32)and posterior approach group(n=33)by random number method.Patients in both groups underwent ultrasound-guided nerve block according to their respective approaches before operation,and were given 20 mL of 0.375%ropivacaine.PCIA analgesia was given after operation.The general clinical characteristics(age,height,weight,BMI,gender,ASA grade),resting and active VAS score and the number of analgesic segments at 4,8,12,24 and 48 h after operation,intraoperative indexes(sufentanil dosage,remifentanil dosage and operation time),postoperative analgesia indexes(consumption of tramadol,effective pressing times of intravenous analgesia pump within 48 h after operation,time required for the first remedial analgesia,number of people required for additional analgesia),rehabilitation indexes(the first time to ambulation after operation,time of pulling out the drainage tube,time of anal exhaust,time of pulling out the urinary tube and hospital stay)and the occurrence of adverse reactions were compared between the two groups.Results At 24 h after operation,the active VAS score in the posterior approach group was lower than that in the lateral approach group,the number of analgesic segments was more than that in the lateral approach group(P<0.05).The consumption of tramadol and effective pressing times of intravenous analgesia pump within 48 h after operation in the posterior approach group were less than those in the lateral approach group,time required for the first remedial analgesia was longer than that in the lateral approach group,and the proportion of people required for additional analgesia was lower than that in the lateral approach group(P<0.05).Conclusion The analgesic effect of ultrasound-guided posterior QLB after retroperitoneal laparoscopic radical nephrectomy is better than that of lateral approach QLB,which can reduce the systemic dosage of postoperative analgesia and prolong the demand time of first remedial analgesia.