超声引导下外侧弓状韧带上腰方肌前路阻滞与腹横肌平面阻滞在子宫切除术中的比较

Comparison of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament and transversus abdominis plane block in hysterectomy

目的评价超声引导下外侧弓状韧带上腰方肌前路阻滞(QLB-LSAL)和腹横肌平面阻滞(TAPB)对开腹子宫切除术患者镇痛效果及术后康复情况的影响。方法选择择期开腹子宫切除术患者60例,年龄35~64岁,BMI 21~29 kg/m^(2),ASAⅠ或Ⅱ级。随机分为两组:QLB-LSAL组(Q组)和TAPB组(T组),每组30例。麻醉诱导前,Q组在超声引导下行双侧QLB-LSAL,T组在超声引导下行双侧TAPB,两组每侧均给予0.375%罗哌卡因20 ml。术毕两组均行患者自控静脉镇痛(PCIA)。记录阻滞后5 min、6、24、48 h的阻滞平面节段,阻滞后6、24、48 h静息和活动时VAS疼痛评分和阻滞后48 h静息时VAS疼痛评分大于4分的发生情况,术后48 h舒芬太尼用量、镇痛泵按压次数和补救镇痛情况,下床活动时间、首次肛门排气时间、术后进食时间、术后住院时间,术后皮肤瘙痒、恶心呕吐等不良反应发生情况。结果阻滞后5 min、6、24、48 h Q组阻滞平面节段明显多于T组(P<0.05)。阻滞后6、24、48 h两组静息和活动时VAS疼痛评分差异无统计学意义,阻滞后48 h时,两组静息时VAS疼痛评分>4分发生率差异无统计学意义。术后48 h内Q组舒芬太尼用量、镇痛泵按压次数明显少于T组(P<0.05),补救镇痛率明显低于T组(P<0.05)。Q组首次下床活动时间、首次肛门排气时间和术后住院时间明显短于T组(P<0.05)。两组术后皮肤瘙痒、恶心呕吐发生率差异无统计学意义。结论与腹横肌平面阻滞比较,超声引导下外侧弓状韧带上腰方肌前路阻滞能有效缓解开腹子宫切除术患者术后疼痛,减少术后镇痛药物用量,术后恢复更快。

Objective To compare the analgesic effect and postoperative recovery of patients undergoing laparotomy hysterectomy with ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament(QLB-LSAL)and transversus abdominis plane block(TAPB).Methods Sixty patients underwent laparotomy hysterectomy,aged 35-64 years,BMI 21-29 kg/m^(2),ASA physical statusⅠorⅡ,were randomly dicided into two groups:the QLB-LSAL group(group Q)and the TAPB(group T),30 patients in each group.Before anesthesia induction,patients underwent bilateral ultrasound-guided QLB-LSAL or TAPB(20 ml of 0.375%ropivacaine on each side).After surgery,both groups received patient-controlled intravenous analgesia(PCIA).The number of block dermatomes at 5 minutes,6,24,48 hours after block were measured.The VAS score at rest and during exercise at 6,24,48 hours after block were recorded,while VAS score at rest at 48 hours after block more than 4 points were calculated.The consumption of sufentanil,the number of pressing PCIA pump and the rate of rescue analgesia using ketorolac tromethamine within 48 hours after surgery were recorded.Postoperative recovery indices such as time of first ambulation,first time of anal exhaust,time to eat,and the postoperative hospital stay were recorded.Postoperative nausea,vomiting,pruritus and other adverse reactions were recorded.Results The total number of block dermatomes in group Q was significantly higher than that in group T 5 minutes,6,24,48 hours after block(P<0.05).There were no significant differences in VAS score between the two groups 6,24,48 hours after block under the context of rest and during exercise.No significant differences between the two groups in the incidence of VAS score more than 4 points at rest 48 hours after block was identified.The consumption of sufentanil,the number of pressing PCIA pump and the rate of rescue analgesia ketorolac tromethamine within 48 hours after surgery in group Q were significantly lower than those in group T(P<0.05).The time of first ambulation,time of first anal exhaust and postoperative hospital stay in group Q were significantly shorter than those in group T(P<0.05).There were no significant differences in the incidence of postoperative nausea,vomiting and pruritus between the two groups.Conclusion Compared with transverse abdominis plane block,ultrasound-guided QLB-LSAL can effectively relieve postoperative pain for patients with laparotomy hysterectomy,reduce postoperative analgesic drug dosage and provide more rapid postoperative recovery.