改良肋下腰方肌前侧阻滞用于腹腔镜肾脏切除术后镇痛的临床效果研究

Study on the clinical effect of modified subcostal and anterior quadratus lumborum block for postoperative analgesia after laparoscopic nephrectomy

目的评价改良与传统肋下腰方肌前侧阻滞用于腹腔镜肾切除术病人术后镇痛的效果。方法选择行腹腔镜肾切除术病人46例,随机分为两组:传统肋下腰方肌前侧阻滞(T)组和改良肋下腰方肌前侧阻滞(M)组,每组23例。麻醉诱导前,T组在超声引导下行传统肋下腰方肌前侧阻滞,M组在超声引导下行改良肋下腰方肌前侧阻滞;均给予0.5%罗哌卡因20 ml。术毕两组均行病人自控静脉镇痛。记录阻滞后5分钟、10分钟和15分钟的温度觉减退平面。记录阻滞后6小时、24小时和48小时静息、咳嗽状态下的VAS疼痛评分。记录术后24小时舒芬太尼用量、镇痛泵按压次数及补救镇痛情况。结果M组在阻滞后5分钟、10分钟和15分钟的阻滞平面节段数量分别为6(4,8)、8(6,9)、8(6,9),明显多于T组的4(2,6)、6(2,9)、6(2,9)(P<0.05)。M组病人在阻滞后6小时静息及咳嗽情况下的VAS疼痛评分分别为(1.6±0.5)分、(3.7±0.6)分,阻滞后24小时分别为(2.3±0.4)分、(3.4±0.4)分,阻滞后48小时分别为(2.5±0.8)分、(3.2±0.7)分,T组在阻滞后6小时静息及咳嗽情况下的VAS疼痛评分分别为(2.5±0.7)分、(5.6±0.8)分,阻滞后24小时分别为(3.1±0.5)分、(4.5±0.7)分,阻滞后48小时分别为(3.3±0.6)分、(4.2±0.6)分,M组均低于T组(P<0.05)。M组术后24小时舒芬太尼用量、镇痛泵按压次数及术后镇痛补救率分别为(23.1±4.3)μg、5(4,7)次、4.3%,均明显低于T组的(34.7±6.8)μg、11(9,12)次、21.7%(P<0.05)。结论超声引导下改良肋下腰方肌前侧阻滞用于腹腔镜肾切除术病人,其镇痛效果优于传统肋下腰方肌阻滞,可减少术后镇痛药物用量,有效缓解术后疼痛。

Objective To evaluate the effect of modified and traditional subcostal and anterior quadratus lumborum block on postoperative analgesia in patients with laparoscopic nephrectomy.Methods 46 patients underwent laparoscopic nephrectomy.They were randomly divided into two groups:traditional subcostal quadratus lumborum block(group T)and modified subcostal quadratus lumborum block(group M),with 23 cases in each group.Before anesthesia induction,the T group was subjected to the traditional subcostal and anterior quadratus lumborum block under ultrasound guidance,and the M group was subjected to the modified subcostal quadratus lumborum block under ultrasound guidance.All were given 0.5%ropivacaine 20 ml.Patients controlled intravenous analgesia(PCIA)was performed in both groups.The dermatomal levels of 5min,10 min and 15min after block was recorded.VAS pain scores at rest and cough were recorded at 6,24 and 48 h after the block.The dosage of Sufentanil,the number of analgesic pump compressions and the flurbiprofen rescue were recorded 24 h after surgery.Results The number of block plane segments in group M at 5,10 and 15 minutes after block were 6(4,8),8(6,9)and 8(6,9),respectively,which were significantly more than the T group[4(2,6),6(2,9),6(2,9)](P<0.05).The VAS pain scores of patients in group M were(1.6±0.5)points at rest and(3.7±0.6)points at cough 6 hours after block,24 hours after the block were(2.3±0.4)points and(3.4±0.4)points,respectively,48 hours after the block were(2.5±0.8)min and(3.2±0.7)min,respectively.The VAS pain scores of and at rest and cough 6 hours after block in T group were(2.5±0.7)points and(5.6±0.8)points,respectively,24 hours after the block were(3.1±0.5)points and(4.5±0.7)points,respectively,48 hours after the block were(3.3±0.6)min and(4.2±0.6)min,respectively.Group M was lower than group T(P<0.05).In group M,the dosage of sufentanil,the times of analgesic pump and the rate of analgesic relief 24 hours after operation were(23.1±4.3)μg,5(4,7)times and 4.3%,respectively,which were significantly lower than those in T group[(34.7±6.8)μg,11(9,12)times,21.7%](P<0.05).Conclusion Ultrasound-guided modified subcostal and anterior quadratus lumborum block has better analgesic effect than traditional technique in patients undergoing laparoscopic nephrectomy,which can reduce the amount of postoperative analgesic drugs and effectively relieve postoperative pain.