超声引导下腰方肌阻滞对剖宫产术后镇痛的影响
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摘要
目的探讨超声引导下腰方肌阻滞(quadratus lumborum block,QLB)对剖宫产术后镇痛效果的影响。方法择期行剖宫产产妇60例,年龄20～40岁,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:QLB组(Q组)和对照组(C组),每组30例。Q组术毕在超声引导下行双侧QLB,每侧注射0.33%罗哌卡因20ml,C组不阻滞。两组术毕均行PCIA,镇痛泵药液配方为曲马多800mg、奈福泮40mg,用生理盐水配成80ml。记录术后4、8、12、24、48h曲马多累计消耗量以及静息、咳嗽、翻身NRS评分、BCS舒适度评分;术后4、8、12、24、48h测定QLB的阻滞平面;记录总体镇痛满意度评分以及术后不良反应的发生情况。结果与C组比较,Q组术后4、8、12、24、48h曲马多累计消耗量明显减少、静息NRS评分明显降低、BCS舒适度评分明显升高,术后12、24h咳嗽NRS评分以及术后4、48h翻身NRS评分明显降低(P<0.05);术后4、8、12hQLB的阻滞平面主要为T7—L1,阻滞的节段数为7,术后24hQLB的阻滞平面主要为T8—L1,阻滞的节段数为6,术后48hQLB的阻滞平面消退;Q组总体镇痛满意度明显高于C组(P<0.05);两组术后恶心呕吐、头晕的发生率差异无统计学意义。结论超声引导下QLB能够明显减少剖宫产术后曲马多用量,降低术后疼痛评分,提高产妇术后舒适度和满意度。
Objective To investigate the effect of ultrasound-guided quadratus lumborum block(QLB)on postoperative analgesia after caesarean section.Methods Sixty parturientsscheduled for cesarean section,aged 20-40 years,ASA physical status Ⅰ orⅡ,were randomly divided into 2 groups(n = 30 each)using a random number table:QLB group(group Q)and control group(group C).Parturients in group Q received bilateral QLB with the use of 20 ml 0.33% ropivacaine per side after surgery,while QLB was not done in group C.Both groups received patient-controlled intravenous analgesia(PCIA)after surgery which contains 800 mg tramadol,40 mg nefopam and 80 ml normal saline.The accumulative consumption of tramadol,the score of numerical rating scale(NRS)for pain at rest and on movement and the bruggrmann comfort scale(BCS)score were recorded at 4,8,12,24,48 hafter operation.The cutaneous sensory block area was determined in group Q at 4,8,12,24,48 hafter operation.The patient′s satisfaction with postoperative analgesia and adverse reactions were also recorded.Results The consumption of tramadol in group Q was significantly decreased compared with that in group C(P<0.05)at 4,8,12,24,48 hafter surgery.NRS for pain at rest at all times,NRS for pain when cough at 12,24 hafter surgery and NRS for pain when turning over at 4,48 hafter surgery were significantly lower,while the BCS score was higher in group Q than that in group C(P<0.05).Quadratus lumborum block affected T7-L1 dermatomes at 4,8,12 hafter surgery and T8-L1 dermatomes at 24 hafter surgery.The analgesic plane of quadratus lumborum block disappeared at 48 hours after operation.The patients satisfaction with postoperative analgesia was higher in group Q compared with that in group C(P<0.05).The incidence of postoperative nausea,vomiting and dizziness was similar between the two groups.Conclusion Ultrasound-guided quadratus lumborum block can remarkably reduce the consumption of tramadol after caesarean section,lower the postoperative pain score,improve the patient′s comfort and satisfaction..
Objective To investigate the effect of ultrasound-guided quadratus lumborum block(QLB)on postoperative analgesia after caesarean section.Methods Sixty parturientsscheduled for cesarean section,aged 20-40 years,ASA physical status Ⅰ orⅡ,were randomly divided into 2 groups(n = 30 each)using a random number table:QLB group(group Q)and control group(group C).Parturients in group Q received bilateral QLB with the use of 20 ml 0.33% ropivacaine per side after surgery,while QLB was not done in group C.Both groups received patient-controlled intravenous analgesia(PCIA)after surgery which contains 800 mg tramadol,40 mg nefopam and 80 ml normal saline.The accumulative consumption of tramadol,the score of numerical rating scale(NRS)for pain at rest and on movement and the bruggrmann comfort scale(BCS)score were recorded at 4,8,12,24,48 hafter operation.The cutaneous sensory block area was determined in group Q at 4,8,12,24,48 hafter operation.The patient′s satisfaction with postoperative analgesia and adverse reactions were also recorded.Results The consumption of tramadol in group Q was significantly decreased compared with that in group C(P<0.05)at 4,8,12,24,48 hafter surgery.NRS for pain at rest at all times,NRS for pain when cough at 12,24 hafter surgery and NRS for pain when turning over at 4,48 hafter surgery were significantly lower,while the BCS score was higher in group Q than that in group C(P<0.05).Quadratus lumborum block affected T7-L1 dermatomes at 4,8,12 hafter surgery and T8-L1 dermatomes at 24 hafter surgery.The analgesic plane of quadratus lumborum block disappeared at 48 hours after operation.The patients satisfaction with postoperative analgesia was higher in group Q compared with that in group C(P<0.05).The incidence of postoperative nausea,vomiting and dizziness was similar between the two groups.Conclusion Ultrasound-guided quadratus lumborum block can remarkably reduce the consumption of tramadol after caesarean section,lower the postoperative pain score,improve the patient′s comfort and satisfaction..
引文
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[4]Ueshima H,Otake H,Lin JA.Ultrasound-guided quadratus lumborum block:an updated review of anatomy and techniques.Biomed Res Int,2017,2017:2752876.
[5]Murouchi T,Iwasaki S,Yamakage M.Quadratus lumborum block:analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery.Reg Anesth Pain Med,2016,41(2):146-150.
[6]Blanco R,Ansari T,Riad W,et al.Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery:a randomized controlled trial.Reg Anesth Pain Med,2016,41(6):757-762.
[7]Parras T,Blanco R.Randomised trial comparing the transversus abdominis plane block posterior approach or quadratus lumborum block typeⅠwith femoral block for postoperative analgesia in femoral neck fracture,both ultrasoundguided.Rev Esp Anestesiol Reanim,2016,63(3):141-148.
[8]李刚,张建欣.超声引导下腰方肌阻滞对经腹直肠癌根治术后镇痛效果的影响.临床麻醉学杂志,2017,33(10):987-990.
[9]Krohg A,Ullensvang K,Rosseland LA,et al.The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery:a randomized clinical trial.Anesth Analg,2018,126(2):559-565.
[10]Carney J,Finnerty O,Rauf J,et al.Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.Anaesthesia,2011,66(11):1023-1030.
[11]Wikner M.Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy.Anaesthesia,2017,72(2):230-232.
[12]SáM,Cardoso JM,Reis H,et al.Quadratus lumborum block:are we aware of its side effects?A report of 2cases.Rev Bras Anestesiol,2018,68(4):396-399.
[13]Griffiths JD,Le NV,Grant S,et al.Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section.Br J Anaesth,2013,110(6):996-1000.
[2]Chou R,Gordon DB,de Leon-Casasola OA,et al.Management of postoperative pain:a clinical practice guideline From the American Pain Society,the American Society of Regional Anesthesia and Pain Medicine,and the American Society of Anesthesiologists′Committee on Regional Anesthesia,Executive Committee,and Administrative Council.J Pain,2016,17(2):131-157.
[3]Blanco R,Ansari T,Girgis E.Quadratus lumborum block for postoperative pain after caesarean section:a randomised controlled trial.Eur J Anaesthesiol,2015,32(11):812-818.
[4]Ueshima H,Otake H,Lin JA.Ultrasound-guided quadratus lumborum block:an updated review of anatomy and techniques.Biomed Res Int,2017,2017:2752876.
[5]Murouchi T,Iwasaki S,Yamakage M.Quadratus lumborum block:analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery.Reg Anesth Pain Med,2016,41(2):146-150.
[6]Blanco R,Ansari T,Riad W,et al.Quadratus lumborum block versus transversus abdominis plane block for postoperative pain after cesarean delivery:a randomized controlled trial.Reg Anesth Pain Med,2016,41(6):757-762.
[7]Parras T,Blanco R.Randomised trial comparing the transversus abdominis plane block posterior approach or quadratus lumborum block typeⅠwith femoral block for postoperative analgesia in femoral neck fracture,both ultrasoundguided.Rev Esp Anestesiol Reanim,2016,63(3):141-148.
[8]李刚,张建欣.超声引导下腰方肌阻滞对经腹直肠癌根治术后镇痛效果的影响.临床麻醉学杂志,2017,33(10):987-990.
[9]Krohg A,Ullensvang K,Rosseland LA,et al.The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery:a randomized clinical trial.Anesth Analg,2018,126(2):559-565.
[10]Carney J,Finnerty O,Rauf J,et al.Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.Anaesthesia,2011,66(11):1023-1030.
[11]Wikner M.Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy.Anaesthesia,2017,72(2):230-232.
[12]SáM,Cardoso JM,Reis H,et al.Quadratus lumborum block:are we aware of its side effects?A report of 2cases.Rev Bras Anestesiol,2018,68(4):396-399.
[13]Griffiths JD,Le NV,Grant S,et al.Symptomatic local anaesthetic toxicity and plasma ropivacaine concentrations after transversus abdominis plane block for Caesarean section.Br J Anaesth,2013,110(6):996-1000.