超声引导下腰方肌阻滞联合全麻用于腹腔镜卵巢囊肿剥除术术后镇痛效果

The analgesic effect of ultrasound-guided quadratus lumborum block combined with general anesthesia for the patients after laparoscopic ovarian cystectomy

目的:探讨超声引导下腰方肌阻滞(QLB)联合全麻对腹腔镜卵巢囊肿剥除术术后镇痛效果的影响。方法:选取2016-2019年本院行腹腔镜卵巢囊肿剥除术患者80例,通过随机数字表法分组,于全麻诱导后QLB组行超声引导下QLB,TAPB组行超声引导下腹横肌平面阻滞(TAPB),麻醉后均行腹腔镜卵巢囊肿剥除术。记录手术时间、苏醒时间、拔管时间以及术中及术后舒芬太尼的用量;术后于2h、6h、12h、24h对两组行静息和运动疼痛视觉模拟评分法(AS)评估;比较两组术后镇痛相关并发症发生率;结果:两组手术时间无差异,QLB组患者苏醒时间(4.0±0.8 min)、气管导管拔出时间(5.3±1.3 min)及术中(29.6±5.8μg)和术后舒芬太尼剂量(17.5±8.3μg)均低于TAPB组(4.7±0.8 min、7.6±1.5 min、36.0±3.6μg、36.2±11.4μg)(P<0.05);静息VAS评分术后2h、6h时QLB组(3.35±1.10分、2.74±0.91分)低于TAPB组(3.86±1.08分、3.16±0.96分)(P<0.05),12h、24h时两组无差异(P>0.05);运动VAS评分术后各时期QLB组均低于TAPB组(P<0.05)。总并发症发生率QLB组(12.5%)低于TAPB组(32.5%)(P<0.05)。结论:QLB联合全麻用于腹腔镜卵巢囊肿剥除术能有效的减少术中及术后舒芬太尼的用量,有效改善术后镇痛效果并减少相关并发症的发生。

Objective:To investigate the influence of quadratus lumborum block(QLB)combined with general anesthesia on the postoperative analgesia of the patients after laparoscopic ovarian cystectomy.Methods:A total of 80 patients who underwent laparoscopic ovarian cystectomy from 2016 to 2019 were selected and were randomly divided into group A and group B.The patients in group A received ultrasound-guided QLB after induction of general anesthesia,and the patients in group B received ultrasound-guided transverse abdominal block(TAPB)after induction of general anesthesia,and the laparoscopic ovarian cystectomy was performed for the patients in the two groups after anesthesia induction.The time of operation,the time of revive from anesthesia,the time of extubation,and the dosage of intraoperative and postoperative sufentanil used of the patients in the two groups were recorded.The scores of resting and moving visual analogue scoring(VAS)of the patients in the two groups at postoperative 2 h,6 h,12 h,and 24 h were evaluated.The incidence of complications related to postoperative analgesia of the patients was compared between the two groups.Results:There was no significant difference in the operation time of the patients between the two groups.The time of revive from anesthesia(4.0±0.8 min),the tracheal catheter extraction time(5.3±1.3 min),the dose of intraoperative sufentanil used(29.6±5.8μg),and the dose of postoperative dose of sufentanil used(17.5±8.3μg)of the patients in group A were significant lower than those(4.7±0.8 min,7.6±1.5 min,36.0±3.6μg,and 36.2±11.4μg)of the patients in group B(P<0.05).The resting VAS score(3.35±1.10 points and 2.74±0.91 points)of the patients in group A at postoperative 2 hand 6 hwere significantly lower than those(3.86±1.08 points and 3.16±0.96 points)of the patients in group B(P<0.05).There were no significant different in the resting VAS score of the patients at postoperative 12 hand 24 hbetween the two groups(P>0.05).The scores of the moving VAS of the patients at postoperative different time in group A were significantly lower than those of the patients in group B(P<0.05).The total complication rate(12.5%)of the patients in group A was significantly lower than that(32.5%)of the patients in group B(P<0.05).Conclusion:QLB combined with general anesthesia during laparoscopic ovarian cystectomy can effectively reduce the dosage of intraoperative and postoperative sufentanil used of the patients,can effectively improve the postoperative analgesic effect,and can reduce the occurrence of related complications of the patients.