两种不同入路腰方肌阻滞在腹腔镜直肠癌根治术中的应用

Application of lumbar quadratus block via superior arcuate ligament or posterior approach in rectal can⁃cer surgery

目的探讨超声引导下弓状韧带上腰方肌阻滞与后路腰方肌阻滞对腹腔镜下直肠癌根治术患者术后镇痛效果及恢复质量的影响。方法选择拟行腹腔镜下直肠癌根治术患者80例,随机将患者分为两组:外侧弓状韧带上腰方肌前侧阻滞组(A组)和后路腰方肌阻滞组(Q组),每组40例。比较两组患者术后48 h舒芬太尼消耗量、术后24 h QoR⁃40评分、首次按压镇痛泵时间、术后静息和运动状态VAS评分、术后48 h补救镇痛发生率、镇痛满意度、术后早期恢复情况及不良反应发生情况。结果与Q组相比,A组患者术后48 h舒芬太尼总消耗量明显降低(P<0.001);A组患者术后6、12、24 h静息与运动状态VAS评分均明显降低(P<0.05);A组患者术后首次按压镇痛泵时间明显晚于Q组(P<0.05);A组患者术后24 h QoR⁃40评分明显高于Q组(P<0.001);两组患者术后48 h补救镇痛发生率、镇痛满意度、首次排气时间、首次下床活动时间、术后恶心呕吐及其他不良反应差异无统计学意义(P>0.05)。结论在腹腔镜下直肠癌根治术中,相较于后路腰方肌阻滞,超声引导下弓状韧带上腰方肌阻滞可以提供更好的镇痛效果,减少患者术后阿片类药物用量,提高患者术后恢复质量。

Objective To investigate the effect of ultrasound⁃guided anterior quadratus lumborum block at the lateral supra⁃arcuate ligament(QLB⁃LSAL)or posterior quadratus lumborum block(QLB2)on postoperative analgesia and postoperative recovery quality in patients undergoing laparoscopic radical resection of rectal cancer.Methods A total of 80 patients who had received laparoscopic radical resection of rectal cancer were selected.The patients were randomly divided into two groups:QLB⁃LSAL group(group A)and QLB2 group(group Q),40 in each group.Sufentanil consumption 48 h after surgery,time to the first PCA,24h QoR⁃40 score after surgery,VAS scores on resting and exercise status at 2 h,6 h,12 h,24 h and 48 h after surgery,incidence of relief anal⁃gesia at 48 h after surgery,satisfaction with analgesia,early postoperative recovery,and occurrence of adverse reactions were compared between the two groups.Results As compared with group Q,the consumption of sufentanil 48 h after surgery,the scores on resting and exercise VAS at 6 h,12 h,and 24 h after surgery in group A were significantly decreased(P<0.05).Time to the first PCA in group A was significantly longer than that in group Q(P<0.05).The 24 h QoR⁃40 score was significantly higher in group A than in group Q(P<0.001).There were no significant differences between the two groups in the incidence of relief analgesia 48 hours after surgery,satis⁃faction with analgesia 48 hours after surgery,first flatus,first ambulation,postoperative nausea and vomiting and other adverse reactions(P>0.05).Conclusions In laparoscopic radical resection of rectal cancer,QLB⁃LSAL,compared with QLB2,can provide better analgesic effect,reduce use of postoperative opioids,and improve the postoperative recovery quality in patients.