超声引导下双侧弓状韧带上腰方肌阻滞在宫颈癌根治术患者术后镇痛的效果

Effects of ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament on postoperative analgesia of patients undergoing radical cervical cancer surgery

目的探讨超声引导下双侧弓状韧带上腰方肌阻滞对开腹宫颈癌根治术患者术后疼痛的影响。方法选择择期行开腹宫颈癌根治术患者59例,年龄21~70岁,BMI 17~27 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:弓状韧带上腰方肌阻滞组(Q组,n=29)和对照组(C组,n=30)。Q组于全麻诱导前在超声引导下行双侧弓状韧带上腰方肌阻滞,分别注射0.375%罗哌卡因20 ml;C组不行神经阻滞。两组均采用全凭静脉麻醉,术后均使用患者自控静脉镇痛(PCIA)。记录阻滞后5、15 min感觉阻滞平面、术后1、6、12、24、48 h静息和活动时VAS疼痛评分、PCA有效按压次数、PCA总按压次数,术中丙泊酚和瑞芬太尼用量、术后48 h内补救镇痛率、苏醒时间、首次下床时间、术后住院时间以及术后恶心呕吐(PONV)、皮肤瘙痒、低血压、呼吸抑制、气胸、肾损伤、股四头肌无力等不良反应和阻滞相关并发症发生情况。结果术后1、6、12、24、48 h Q组静息和活动时VAS疼痛评分明显低于C组(P<0.05),PCA有效按压次数和总按压次数明显少于C组(P<0.05),术中瑞芬太尼用量明显少于C组(P<0.05),术后48 h内补救镇痛率明显低于C组(P<0.05),苏醒时间、首次下床时间、术后住院时间明显短于C组(P<0.05)。两组丙泊酚用量差异无统计学意义。Q组术后PONV发生率明显低于C组(P<0.05),两组皮肤瘙痒发生率差异无统计学意义。Q组术后未出现低血压、呼吸抑制、气胸、肾损伤、股四头肌无力等阻滞相关并发症。结论超声引导下弓状韧带上腰方肌阻滞可明显减轻开腹宫颈癌根治术患者术后疼痛,减少围术期全身麻醉镇痛药用量,降低术后恶心呕吐发生率,促进患者康复。

Objective To investigate the effect of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament on postoperative pain of patients undergoing open radical cervical cancer surgery.Methods Sixty patients,aged 21-70 years,BMI 17-27 kg/m^(2),ASA physical statusⅠorⅡ,scheduled for open radical cervical cancer surgery were divided into two groups according to random number table method:the anterior quadratus lumborum block at the lateral supra-arcuate ligament group(group Q,n=29)and the control group(group C,n=30).Ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament was performed before surgery,and 0.375%ropivacaine 20 ml were bilaterally injected in group Q.Group C were not blocked.Both groups were treated under total intravenous anesthesia.Then patient-controlled intravenous analgesia(PCIA)was used.The sensory block of dermatomes 5 and 15 minutes after injection were recorded in group Q.The VAS score at rest and during exercise at 1,6,12,24,and 48 hours after surgery were recorded in both groups,as well as the total number and the valid number of pressing PCA pump.The amount of intraoperative anesthetic drugs,the rate of rescue analgesia at 48 hours after surgery,the awakening time,the first time of getting out of bed,the time of hospital stay,the adverse reactions and the blockage-related complications such as nausea and vomiting(PONV),pruritus,hypotension,respiratory depression,pneumothorax,kidney injury or quadriceps weakness were recorded.Results The VAS score at rest and during exercise 1,6,12,24,and 48 hours after surgery in group Q were significantly lower than those in group C(P<0.05).The total number and the valid number of pressing PCA pump in group Q were significantly lower than those in group C(P<0.05).The rate of rescue analgesia at 48 hours after surgery was significantly lower in group Q than that in group C(P<0.05).The cumulative consumption of remifentanil and the incidence of PONV in group Q were significantly lower than those in group C(P<0.05).Meanwhile,the awakening time,the first time of getting out of bed and the time of hospital stay in group Q were significantly earlier than those in group C(P<0.05).There were no significant difference in the cumulative consumption of propofol and the incidence of pruritus between the two groups.There were no blockage-related complications in group Q,such as hypotension,respiratory depression,pneumothorax,kidney injury or quadriceps weakness.Conclusion Ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament can relieve the postoperative pain significantly,reduce the perioperative analgesic dosage required and the incidence of nausea and vomiting,promote the recovery for the patients undergoing open radical cervical cancer.