超声引导下腰方肌阻滞在经皮肾镜取石术后镇痛疗效的观察

Observation on the analgesic effect of ultrasound-guided quadratus lumborum block after percutaneous nephrolithotomy

目的探讨超声引导下经肌肉入路腰方肌阻滞(QLB-TM)用于经皮肾镜取石术患者术后镇痛的有效性及安全性。方法选取2020年4月至6月行经皮肾镜取石术患者60例,采用随机数字表法分为肌肉入路腰方肌阻滞组(Q组)及对照组(C组)各30例。两组均采用常规麻醉,其中Q组于麻醉诱导前行超声引导下经肌肉入路腰方肌阻滞,到达目标筋膜间隙后单次注射0.375%罗哌卡因0.5 ml/kg;C组术前不进行神经阻滞。观察拔管后30 min(T0)、4 h(T1)、8 h(T2)、20 h(T3)、24 h(T4)、28 h(T5)、32 h(T6)、44 h(T7)、48 h(T8)静息状态下视觉模拟量表(VAS)评分以及术后24、48 h运动状态下VAS评分,评估术中舒芬太尼、术后镇痛药物的消耗量,双侧下肢肌力以及相关不良事件的发生率。结果Q组患者T0~T6的静息疼痛评分明显低于C组,术后24 h运动VAS评分低于C组(P<0.05);两组术后48 h的静息和运动下疼痛评分比较,差异无统计学意义(P>0.05);Q组术中舒芬太尼及单位时间消耗量明显少于C组(P<0.05),两组患者术后镇痛药物的消耗量、住院天数以及双侧下肢肌力等不良事件的发生率比较,差异无统计学意义(P>0.05)。结论QLB-TM用于经皮肾镜取石术术后镇痛是安全有效的,有较好的临床应用价值。

Objective To evaluate the efficacy and safety of ultrasound-guided transmuscular quadratus lumborum block(TM-QLB)for postoperative analgesia in patients undergoing percutaneous nephrolithotomy.Methods Sixty patients scheduled for percutaneous nephrolithotomy under general anesthesia from April to June 2020 were selected.The patients were randomly divided into a control group(C group)and a transmuscular quadratus lumborum block group(Q group),30 in each group.Both groups received conventional anesthesia,and before anesthesia induction,the group Q underwent ultrasound-guided TM-QLB before anesthesia induction,i.e.a single injection of 0375%ropivacaine 05 ml/kg was performed after reaching the target fascial space.The group C had no nerve block before surgery.The static and ambulatory visual analogue scale(VAS)scores at 30 min(T0),4 h(T1),8 h(T2),20 h(T3),24 h(T4),28 h(T5),32 h(T6),44 h(T7)and 48 h(T8)after extubation were observed.The VAS scores in the exercise state at 24 and 48 hours after operation were also observed.The intraoperative consumption of sufentanil and postoperative analgesic,and the incidence of related adverse events including the muscle strength of bilateral lower limbs were evaluated.Results Compared with the C group,the VAS scores in resting state at the Q group at T0~T6 after extubation was significantly lower(P<0.05).The ambulatory VAS score of the Q group at 24 h after operation was also significantly lower than that of the C group(P<0.05).However,there was no significant difference between the two groups at 48 hours after operation(P>005).The intraoperative consumption and unit time consumption of sufentanil in the Q group were significantly less than those in the C group(P<0.05).There was no significant difference in the consumption of postoperative analgesics,the length of hospital stay(LOS)and the incidence of adverse events such as lower limb muscle weakness between the two groups(P>0.05).Conclusions TM-QLB is safe and effective for postoperative analgesia after percutaneous nephrolithotomy.It has a great value in clinical application.