超声引导下弓状韧带上腰方肌阻滞对老年肾癌根治术后疼痛及早期康复的影响

Effects of ultrasound guided anterior quadratuslumborum block at lateral supra arcuate ligament on postoperative pain and early recovery in elderly patients undergoing laparoscopic radical nephrectomy

目的 探讨超声引导下弓状韧带上腰方肌阻滞对行后腹腔镜肾癌根治术的老年患者术后疼痛及早期康复的影响。方法 选择本院择期行后腹腔镜肾癌根治术的老年患者80例,年龄65~75岁,ASAⅠ~Ⅲ级。随机将患者分为两组:弓状韧带上腰方肌阻滞组(Q组)和对照组(C组),每组40例。比较两组术后48 h内补救镇痛例数、视觉模拟疼痛评分(VAS评分)、患者自控镇痛(PCA)有效按压次数、术中镇痛药物用量及术后早期康复指标。结果 与C组比较,Q组术后48 h补救镇痛人数减少,术后1、12、24、48 h VAS评分降低,PCA有效按压次数减少(P <0.05);苏醒时间、首次下床时间、术后住院天数缩短,瑞芬太尼用量、恶心呕吐发生率明显减少(P <0.05)。结论 超声引导下弓状韧带上腰方肌阻滞可明显改善后腹腔镜肾癌根治术老年患者术后疼痛,减少镇痛药物用量,降低术后恶心呕吐发生率,促进患者早期康复。

Objective To investigate the effect of ultrasound-guided anterior quadratuslumborum block at lateral supra arcuate ligament on postoperative pain and early recovery in elderly patients undergoing laparoscopic radical nephrectomy.Methods Eighty patients aged 65 to 75,ASA gradeⅠtoⅢ,scheduled for laparoscopic radical nephrectomy were randomly divided into two groups(n=40):an anterior quadratuslumborum block at lateral supra-arcuate ligament group(group Q)and a control group(group C).The rate of remedial analgesia,the Visual analogue scale(VAS)score,the effective pressing times of patient-controlled analgesia(PCA)in 48 hours after surgery,and uses of intraoperative anesthetic dosage and the early recovery indexes were recorded in both groups.Results The rate of remedial analgesia in 48 hours after surgery and the VAS score at postoperative hours1,12,24 and 48 were significantly lower in group Q than in group C(P<0.05).The effective pressing times of PCA were significantly fewer in group Q than in group C(P<0.05).The cumulative uses of remifentanil and the incidence of nausea and vomiting were significantly lower in group Q than in group C(P<0.05).The awakening time,initial time to getting out of bed,and postoperative hospital stay were significantly shorter in group Q than in group C(P<0.05).Conclusions Ultrasound guided anterior quadratuslumborum block at lateral supra arcuate ligament can markedly relieve perioperative pain,reduce uses of perioperative analgesic dosage and the incidence of nausea and vomiting,and accelerate the early recovery in elderly patients undergoing laparoscopic radical nephrectomy.