超声引导下外侧弓状韧带上腰方肌阻滞在开腹肝脏手术中的应用

Effect of ultrasound-guided quadratus lumborum block at the lateral supra arcuate ligament for open liver surgery

目的观察超声引导下外侧弓状韧带上腰方肌阻滞(LSQLB)与肋缘下腹横肌平面阻滞(TAPB)用于开腹肝脏手术的镇痛效果。方法选择丽水市中心医院2021年2月至10月择期行开腹肝脏手术患者42例,采用随机数字表法分为2组,LSQLB组(L组,n=21)和TAPB组(T组,n=21)。两组均在术前行超声引导下神经阻滞,L组行超声引导下右侧LSQLB,T组行右侧肋缘下TAPB,随后在全身麻醉下完成手术。两组患者术后均行静脉自控镇痛(PCIA)。比较两组患者切皮前(T0)、切皮即刻(T1)、肝脏探查时(T2)、缝皮时(T3)的平均动脉压(MAP)和心率(HR);记录术中舒芬太尼、瑞芬太尼的使用量;记录术后2、8、16、24、48 h的疼痛视觉模拟评分(VAS)和术后48 h镇痛泵的按压次数、补救镇痛次数;记录术后肌力减退(阻滞侧下肢肌力≤4级)、低血压、恶心呕吐等不良反应的发生率。结果L组在T1、T2、T3的MAP和HR低于T组(均P<0.05),术中舒芬太尼及瑞芬太尼用量少于T组(均P<0.05),术后2、8、16、24 h的VAS评分低于T组(均P<0.05),术后48 h的镇痛泵按压次数和补救镇痛次数少于T组(均P<0.05)。两组患者术后肌力减退、低血压、恶心呕吐等不良反应发生率差异无统计学意义(均P>0.05)。结论超声引导下LSQLB用于开腹肝脏手术,血流动力学更稳定,镇痛效果更确切。

Objective To investigate the analgesic effect of ultrasound-guided quadratus lumborum block at the lateral supra arcuate ligament(LSQLB)and subcostal transversus abdominis plane block(TAPB)for open liver surgery.Methods Forty-two patients who underwent elective open liver surgery in Lishui Central Hospital from February 2021 to October 2021 were randomly divided into two groups:LSQLB group(L group,n=21)and TAPB group(T group,n=21).Both groups underwent preoperative ultrasound-guided nerve block,and then LSQLB in group L and subcostal TAPB under the right costal margin in group T.The surgery was subsequently completed under general anesthesia.Patient controlled intravenous analgesia(PCIA)was performed in both groups.The mean arterial pressure(MAP)and heart rate(HR)before skin cutting(T0),immediately after skin cutting(T1),at the time of liver exploration(T2),and at the time of suturing(T3)were compared between the two groups;the intraoperative sufentanil and remifentanil consumption was recorded;the visual analogue score(VAS)of pain at 2,8,16,24,and 48 h postoperatively and the number of analgesic pump presses and remedial analgesia at 48 h postoperatively were recorded.The incidence of adverse effects such as postoperative hypotonia(lower limb muscle strength≤grade 4 on the blocked side),hypotension,nausea and vomiting were recorded.Results The MAP and HR at T1,T2 and T3,the dosage of sufentanil and remifentanil during operation of group L were lower than those of group T(all P<0.05);the VAS score at 2,8,16 and 24 hours after operation in group L were lower than those of group T(all P<0.05).The number of analgesic pump presses and remedial analgesia at 48 hours postoperatively in group L were less than those in group T after operation(all P<0.05).There was no statistically significant difference in the incidence of adverse reactions such as postoperative hypokinesia,hypotension,nausea and vomiting in the two groups(all P>0.05).Conclusions LSQLB for open liver surgery is more hemodynamically stable and has a more definite analgesic effect.