超声引导腰方肌阻滞与竖脊肌平面阻滞用于腹腔镜肾切除术后镇痛效果的比较

Comparison of the Postoperative Analgesia Effect of Ultrasound-Guided Quadratus Lumborum Block and Erector Spinae Plane Block in Laparoscopic Nephrectomy

目的:比较腰方肌阻滞(Quadratus lumborum block,QLB)与竖脊肌平面阻滞(Erector spinae plane block,ESPB)用于腹腔镜肾切除术的术后镇痛效果。方法:选择腹腔镜肾切除术的患者60例,将患者分为两组(n=30):腰方肌阻滞组(Q组)和竖脊肌平面阻滞组(E组)。常规全身麻醉下行腹腔镜肾切除术,术毕Q组行QLB,E组行ESPB,随之接静脉自控镇痛泵。观察术后24 h内吗啡总用量、镇痛泵有效按压次数;记录术后2、4、8、12和24 h患者的静止时视觉模拟评分(Rest visual analogue score,RVAS)及主动运动时视觉模拟评分(Movement visual analogue score,MVAS);记录两组穿刺时间、穿刺针调整次数、穿刺成功率、患者满意度评分及术后不良反应发生情况。结果:Q组与E组比较,吗啡总用量[(7.6±3.4)mg vs(12.9±4.7)mg]、镇痛泵有效按压次数[(3.8±2.2)vs(6.2±2.6)]及术后2、4、8、12、24 h的RVAS和MVAS评分Q组均低于E组(P<0.05)。E组穿刺时间短于Q组[(7.2±1.1)min vs(10.1±1.0)min,P<0.05],穿刺针调整次数少于Q组[(1.2±0.3)vs(1.9±0.4),P<0.05],两组穿刺成功率的比较无统计学差异(P>0.05),两组术后24 h内不良反应发生率的比较无统计学差异(P>0.05),Q组的患者满意度高于E组(P<0.05)。结论:在腹腔镜肾切除术后,与ESPB相比,QLB镇痛效果更显著;而ESPB穿刺调整次数及耗时更少,更利于临床操作实施。

Objective:To compare the Postoperative analgesia effect of quadratus lumborum block(QLB)and erector spinae plane block(ESPB)after laparoscopic nephrectomy.Methods:Sixty patients scheduled for laparoscopic nephrectomy under general anesthesia,were divided into two groups(n=30):quadratus lumborum block group(group Q)and erector spinae plane block group(group E).Laparoscopic nephrectomy was performed under routine general anesthesia,patients in group Q receive quadratus lumborum block,patients in group E receive erector spinae plane block.In-travenous controlled analgesia pump was concomitantly received in two groups.The total amount of morphine and effective pressing times of 24 h were recorded.The rest visual analogue score(RVAS)and movement visual analogue score(MVAS)pain scores of patients at 2,4,8,12 and 24 h after operation were recorded.The puncture operation time,number of needle adjustments,success rate of puncture,patients'satisfaction score and adverse reactions within 24 hours after operation were recorded in both groups.Results:Compared with group E,the total amount of morphine in group Q(7.6±3.4)mg vs(12.9±4.7)mg,the effective pressing times(3.8±2.2)vs(6.2±2.6)and RVAS and MVAS scores at 2 h,4 h,6 h,8 h,12 h,24 h after operation were lower in group Q(P<0.05),and number of needle adjustments was lower than that in group Q(P<0.05).There was no significant difference between the two groups in the success rate of puncture(P>0.05).There was no statistical difference between the two groups in adverse reactions within 24 hours after operation(P>0.05).The patients'satisfaction score in group Q was higher than that in group E(P<0.05).Conclusion:Compared with ESPB,QLB had more significant analgesic effect,while ESPB had lower number of needle adjustments and shorter puncture time,which was beneficial to clinical operation implementation.