三种不同区域麻醉方法对腹腔镜下结肠癌根治术患者术后镇痛的比较

Comparison of postoperative analgesia among the three different regional anesthesia methods for the patients undergoing laparoscopic radical colorectal cancer surgery

目的:对比局部浸润麻醉(local infiltration analgesia,LIA)、腹横肌平面阻滞(transversus abdominis plane block,TAPB)和腰方肌阻滞(quadratus lumborum block,QLB)用于腹腔镜下结直肠癌根治术患者术后切口痛和内脏痛的临床效果。方法:选取阜宁县人民医院2020年2月—2024年3月接受腹腔镜下结直肠癌根治术患者123例,年龄≥30岁,ASAⅠ~Ⅲ级,随机分为LIA组(42例)、TAPB组(42例)、QLB组(39例)。LIA组缝皮时在切口和切口近处,逐层浸润0.375%罗哌卡因40 mL;TAPB组每侧腹横肌平面各注射0.375%罗哌卡因20 mL,共40 mL;QLB组每侧腰方肌各注射0.375%罗哌卡因20 mL,共40 mL。使用视觉模拟评分(visual analogue score,VAS)法评估患者拔管后20 min和术后2、4、8、12、24 h的切口痛和内脏痛情况;观察患者24 h内心动过缓、瘙痒、嗜睡、头晕、恶心呕吐等不良反应的发生情况。结果:3组患者的年龄、性别、ASA分级、BMI、术中芬太尼用量和苏醒时间等差异均无统计学意义(均P>0.05)。TAPB组在术后12 h(P=0.007)的静息状态下切口痛VAS评分与LIA组比较差异有统计学意义(P<0.05);QLB组在术后8 h(P<0.001)、术后12 h(P=0.001)的静息状态下切口痛VAS评分与LIA组比较差异有统计学意义(P<0.05)。QLB组拔管后20 min(P<0.001、P=0.010)、术后2 h(P=0.007、0.022)的静息状态下内脏痛VAS评分均显著低于LIA组和TAPB组。3组患者的不良反应发生率差异均无统计学意义(均P>0.05)。结论:QLB较LIA和TAPB能为腹腔镜下结直肠癌根治术患者提供更完善、更持久的镇痛效果。

Objective:To compare the postoperative incisional and visceral pain among local infiltration analgesia(LIA),transversus abdominis plane block(TAPB)and quadratus lumborum block(QLB)for the patients undergoing laparoscopic radical colorectal cancer surgery.Methods:123 patients admitted to Funing People's Hospital from February 2020 to March 2024,who underwent laparoscopic radical colorectal cancer surgery,age of 30 years or over,ASA physical statusⅠ-Ⅲ,were randomly divided into LIA group(42 cases),TAPB group(42 cases),and QLB group(39 cases).The LIA group received incision infiltration layer by layer at the incision with 0.375%ropivacaine 40 mL during skin suture;the TAPB group received 0.375%ropivacaine 20 mL on each side for transversus abdominis plane block,a total amount of 40 mL;the QLB group received 0.375%ropivacaine 20 mL on each group for quadratus lumborum block,a total amount of 40 mL.Visual analogue score(VAS)was used to evaluate the incisional and visceral pain of the patients at 20 min after extubation,and 2,4,8,12,24 h after operation.The occurrence of adverse reactions in three groups was observed within 24 h,including bradycardia,itching,sleepiness,dizziness,nausea and vomiting.Results:There were no significant differences about the age,gender,ASA classification,BMI,intraoperative fentanil dose,and awakening time among the three groups(all P>0.05).The incisional pain-related resting VAS scoring of TAPB group at 12 h(P=0.007)after operation was significant difference compared with the LIA group.The incisional pain-related resting VAS scoring of QLB group at 8 h(P<0.001),12 h(P=0.001)after operation were significant difference compared with the LIA group.The visceral pain-related resting VAS scoring of QLB group were decreased slightly at 20 min after extubation(P<0.001,P=0.010),and 2 h after operation(P=0.007,0.022)than the LIA group and TAPB group.There were no significant differences in adverse reactions among the three groups(P>0.05).Conclusion:QLB provides a lasting and satisfac-tory incisional and visceral pain-related analgesic effect than the LIA and TAPB for the patients undergoing laparoscopic radical colorectal cancer surgery.