术前超声引导下双侧腰方肌阻滞对腹腔镜手术患者围手术期疼痛的影响

Effect of preoperative ultrasound-guided quadratuslumborum block on perioperative pain in patients undergoing laparoscopic surgery

目的观察术前双侧后入路腰方肌阻滞(QLB)对腹腔镜结直肠癌根治术患者围手术期疼痛管理的影响。方法选取2021年5月—2022年9月在同济大学附属同济医院行腹腔镜结直肠癌根治术治疗的60例全身麻醉患者,应用随机数字表法将其分为QLB组和对照组,每组30例。QLB组麻醉诱导前行超声引导下双侧QLB,术中采用全身麻醉。对照组仅采用全身麻醉。术毕两组均使用患者自控经静脉镇痛(PCIA)装置,采用无线远程监控患者自控镇痛系统进行跟踪统计。记录术中心率(HR)、平均动脉压(MAP)、镇痛药物舒芬太尼总用量和手术时间。术后1、3、6、24、48 h进行疼痛视觉模拟评分法(VAS)评分。记录PCIA 24 h使用量、PCIA按压总次数及有效次数和第1次PCIA时间。记录患者术后镇痛满意度。术后3个月电话随访进行疼痛评分。结果QLB组患者手术切皮时的HR和MAP低于对照组,术中舒芬太尼总用量少于对照组,差异均有统计学意义(P<0.05)。QLB组术后1、3、6 h的VAS评分低于对照组,差异均有统计学意义(P<0.05)。QLB组PCIA 24 h使用量和按压总次数少于对照组,第1次PCIA时间晚于对照组,差异均有统计学意义(P<0.05)。结论术前超声引导下QLB用于腹腔镜结直肠癌根治术能起到良好的麻醉协同作用和术后镇痛效果,可优化腹腔镜结直肠癌根治术患者围手术期疼痛管理。

Objective To observe the effect of preoperative quadratuslumborum block(QLB)on perioperative pain in patients undergoing laparoscopic radical colorectal cancer resection.Methods A total of 60 patients were selected,who were under general anesthesia for laparoscopic colorectal cancer resection.They were randomized to two groups:QLB group and control group,with 30 patients in each group.In the QLB group,QLB was performed under ultrasound guidance before operation,then general anesthesia was applied.The control group received general anesthesia only.The two groups of patients were given patient controlled intravenous analgesia(PCIA)after operation and monitored with a remote iPain-Free system.Heart rate(HR),mean artery pressure(MAP),sufentanil amount,and operation time were recorded during the operation.Visual analogue scale(VAS)scores were recorded on postoperative 1,3,6,24,and 48 h.The 24 h usage of PCIA,the total number and effective number of PCIA compressions,and the time of the first PCIA were recorded.Patientssatisfaction with postoperative analgesia was recorded.Pain scores were recorded at 3 months postoperative follow-up telephone visits.Results The HR and MAP of the QLB group during operation were lower than those of the control group,and the intraoperative sufentanil usage was significantly less in the QLB group than that in the control group(P<0.05).The VAS scores of patients in the QLB group at postoperative 1,3,and 6 h were significantly lower than those in the control group(P<0.05).The 24 h usage of PCIA and the total number of PCIA compressions in the QLB group were less than those in the control group,and the first PCIA time was later(P<0.05).Conclusion Preoperative ultrasound-guided QLB in laparoscopic colorectal cancer resection can play a good anesthetic synergy and good postoperative analgesic effect,and can optimize the perioperative pain management in patients undergoing laparoscopic radical resection of colorectal cancer.