弓状韧带上腰方肌阻滞对妇科腹腔镜全子宫切除术后镇痛的影响

Effect of superior arcuate ligamenta quadrate block on analgesia after gynecological laparoscopic total hysterectomy

目的 探讨弓状韧带上腰方肌阻滞对妇科腹腔镜全子宫切除术后镇痛的效果。方法选择择期行腹腔镜全子宫切除术患者100例,年龄35~64岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:弓状韧带上腰方肌阻滞联合全麻组(AL)和全麻组(CG),每组50例。AL组给予0.375%罗哌卡因40 ml行弓状韧带上腰方肌阻滞联合全身麻醉。CG接受常规气管插管全身麻醉。记录手术时间、瑞芬太尼和丙泊酚总用量,术后2、12、24和48 h静息和活动(翻身)时VAS疼痛评分、术后48 h内镇痛泵有效按压次数,头晕、恶心呕吐、呼吸抑制、瘙痒等麻醉相关不良反应发生情况。结果 与CG组比较,AL组瑞芬太尼和丙泊酚总用量、术后48 h内镇痛泵有效按压次数明显减少(P<0.05),术后2、12、24和48 h静息和活动时VAS疼痛评分明显降低(P<0.05),头晕、恶心呕吐、瘙痒等麻醉相关不良反应发生率明显降低(P<0.05)。两组手术时间差异无统计学意义。结论 弓状韧带上腰方肌阻滞能够提高腹腔镜全子宫切除术的麻醉效果,减少麻醉和镇痛药物用量,减轻术后疼痛,减少不良反应。

Objective To investigate the analgesic effect of superior arcuate ligament block on total hysterectomy by gynecological laparoscopic.Methods A total of 100 patients who underwent elective laparoscopic total hysterectomy,aged 35-64 years,BMI 18-28 kg/m^(2),ASA physical status Ⅰ or Ⅱ,were selected.The patients were divided into two groups by random number table method:the conventional group(group CG) and the superior arcuate ligament quadratus block group(group AL),50 patients in each group.Group AL received general anesthesia combined with quadrangular block of superior arcuate ligament(0.375% ropivacaine 40 ml).Group CG received general anesthesia with routine tracheal intubation.The time of operation,the total dosage of remifentanil and propofol during the operation,number of effective analgesic pump compression within 48 hours after the operation,VAS pain scores at rest and activity(turning over) at 2,12,24,and 48 hours after surgery,dizziness,nausea and vomiting,respiratory depression,pruritus,and other anesthesia-related adverse reactions after the operation were compared.ResultsCompared with group CG,the total dosage of remifentanil and propofol,the number of effective analgesic pump compressions within 48 hours after surgery,the VAS pain scores at 2,12,24,and 48 hours after surgery,at rest and moving were significantly lower in group AL(P < 0.05),and there were statistically significant differences in anesthetic-related adverse reactions such as dizziness,nausea and vomiting and pruritus(P < 0.05).There was no significant difference in operation time between the two groups.ConclusionSuperior arcuate ligamentum quadratus block can improve the anesthesia effect of laparoscopic total hysterectomy,reduce the amount of anesthesia and analgesic drugs,and reduce the degree of postoperative pain with good safety.