超声引导下经弓状韧带上或前路腰方肌阻滞在腹腔镜全子宫切除术中的比较

Ultrasound-guided quadratus lumborum block at the lateral supra-arcuate ligament or anterior quadratus lumbosum block in laparoscopic total hysterectomy

目的探讨超声引导下经弓状韧带上入路或前路腰方肌阻滞(QLB)在腹腔镜全子宫切除术中的镇痛效果。方法择期行腹腔镜全子宫切除术的患者38例,年龄18~64岁,BMI 16~29 kg/m^(2),ASAⅠ或Ⅱ级。随机分为经前路QLB组(C组)和经弓状韧带上QLB组(E组),每组19例。麻醉诱导前在超声引导下C组行双侧前路QLB,E组行弓状韧带上QLB,每侧给予0.3%罗哌卡因20 ml。记录术后住院时间、阻滞操作时间、阻滞后起效时间,测定阻滞后5、10、20、30 min的阻滞平面和术中瑞芬太尼和麻黄碱用量。记录术后2、6、12、24、48 h的VAS疼痛评分和补救镇痛,局麻药中毒、血肿、严重低血压、内脏损伤、肌力下降等神经阻滞并发症和恶心呕吐等不良反应。结果两组术后住院时间、阻滞操作时间差异无统计学意义。E组阻滞起效时间明显短于C组(P<0.05)。阻滞后5、10、20、30 min E组阻滞平面节段数量明显多于C组(P<0.05)。术后2、6、12 h E组静息和活动时VAS疼痛评分明显低于C组(P<0.05)。两组均无补救镇痛,术中瑞芬太尼、麻黄碱用量,局麻药中毒、血肿、严重低血压、内脏损伤、肌力下降等神经阻滞并发症和恶心呕吐等不良反应差异无统计学意义。结论在腹腔镜全子宫切除术中经弓状韧带上腰方肌阻滞较传统前路腰方肌阻滞起效更快,阻滞平面更广,术后12 h镇痛效果更好。

Objective To investigate the analgesic effect of ultrasound-guided quadratus lumborum block(QLB)at the lateral supra-arcuate ligament and anterior quadratus lumborum block in patients underwent laparoscopic total hysterectomy(LTH).Methods Thirty-eight patients underwent elective LTH,aged 18-64 years,BMI 16-29 kg/m^(2),ASA physical statusⅠorⅡ,were randomly divided into two groups:anterior QLB group(group C)and anterior QLB at the lateral supra-arcuate ligament group(group E),19 patients in each group.Before anesthesia induction,patients in group C underwent bilateral anterior QLB and group E underwent supra-arcuate ligament QLB under the guidance of ultrasound,and received 20 ml of 0.3%ropivacaine on each side.The postoperative hospital stays,the operation time of block,the onset time after block were recorded.The block plane of 5,10,20,30 minutes after the block were measured.Inoperative refentanil and ephedrine dosage,2,6,12,24,48 hours postoperative VAS scores,additional analgesia,local anesthetic poisoning,hematoma,severe hypotension,visceral injury,muscle strength decline and other nerve block complications and adverse reactions such as nausea and vomiting were recorded.Results There was no significant difference in postoperative hospital stays and the operation time of block between the two groups.The onset time of group E was significantly shorter than that of group C(P<0.05).The VAS pain scores 2,6,12 hours after surgery when resting and moving of group E was significantly lower than group C(P<0.05).No additional analgesia in both groups.There was no significant difference in the dosage of remifentanil and ephedrine intraoperative,nerve block complications such as local anesthetic poisoning,hematoma,severe hypotension,visceral injury and muscle strength decline,and adverse reactions such as nausea and vomiting between the two groups.Conclusion The ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament has more rapid onset time and wider block planes than the traditional anterior quadratus lumborum block,meanwhile the analgesic effect 12 hours after surgery is better than that of the traditional anterior quadratus lumborum block.