后路腰方肌阻滞对二次剖宫产术后子宫复旧痛的影响

Effect of posterior quadratus lumborum block on uterine involution pain in patients with secondary cesarean section

目的观察后路腰方肌阻滞(QLB)对二次剖宫产产妇术后子宫复旧痛及术后早期恢复的影响。方法选择2020年6—12月因瘢痕子宫行二次剖宫产产妇73例,年龄22~40岁,体重50~90 kg,ASAⅠ或Ⅱ级,单胎足月妊娠,采用随机数字表法将产妇分为两组:观察组(n=36)和对照组(n=37)。观察组术毕在超声引导下行双侧后路QLB,对照组模仿观察组超声下寻找腰方肌但不给药。术后24 h和48 h随访并记录产妇子宫复旧痛评分(VAS疼痛评分)和镇痛泵按压次数,并完成术后恢复量表(QoR-40)问卷,以及记录术后初次母乳喂养时间、首次下床活动时间和首次进食时间,以及麻醉相关并发症发生情况。结果与对照组比较,观察组术后24 h内及24~48 h最严重及最轻微子宫复旧痛评分明显降低,观察组术后镇痛泵总按压次数及有效按压次数明显减少,术后恢复量表问卷得分明显升高,术后初次母乳喂养时间明显缩短(P<0.05)。两组首次下床活动时间和首次进食时间及麻醉相关并发症发生率差异无统计学意义。结论后路腰方肌阻滞可降低二次剖宫产产妇术后48 h内子宫复旧痛程度,缩短初次母乳喂养时间,减少术后阿片药物用量并促进产妇术后早期恢复。

Objective To observe the effect of posterior quadratus lumbosus block(QLB)on postoperative uterine involution pain in patients with secondary cesarean section and its influence on early postoperative recovery.Methods From June to December 2020,seventy-three patients with secondary cesarean section due to scar uterus,aged 22-40 years,weighing 50-90 kg,ASA physical statusⅠorⅡ,were divided into two groups by random number table method:the observation group(n=36)and the control group(n=37).The observation group was subjected to bilateral posterior QLB under ultrasound guidance after surgery,and the control group was searched for quadratus lumbosum muscle under ultrasound without medication.The patients were followed up 24 h and 48h after surgery and the pain score of uterine involution(VAS score),the times of analgesic pump press,the postoperative recovery scale(QoR-40)questionnaire were recorded.The time of first breast feeding,the time of first getting out of bed,the time of first feeding,and the anaesthesia related adverse reactions were recorded.Results Compared with the control group,the VAS score of the most severe uterine involution pain after operation was significantly lower,the total number of effective pressing of postoperative analgesia pump were significantly lower,the score of postoperative recovery scale questionnaire was significantly higher,the time of initial breast feeding after operation was significantly shortened in the observation group(P<0.05).There were no significant differences in the time of first out of bed activity,the time of first feeding and anesthesia related complications between the two groups.Conclusion Posterior quadratus lumbosum block can reduce the degree of uterine involution pain in patients with secondary cesarean section within 48 hours after operation,shorten the time of primary breast feeding,reduce the amount of postoperative opioids,and promote early postoperative recovery.