超声引导腰方肌阻滞对腹腔镜肾切除术后镇痛效果的影响
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摘要
目的观察超声引导腰方肌阻滞(QLB)对腹腔镜肾切除术后镇痛效果的影响。方法选择腹腔镜肾切除患者60例,随机分为腰方肌阻滞组(Q组,0.4%罗哌卡因20 mL)和对照组(C组,生理盐水),各30例。常规全麻下行手术,术毕行超声引导手术侧QLB。术后均给予静脉自控镇痛泵,如患者VAS评分> 4,给予氟比洛芬酯。观察两组术后24 h镇痛泵按压次数、舒芬太尼总消耗量、氟比洛芬酯用量,及术后即刻、2、4、6、12、24 h的VAS评分;比较两组术后不良反应情况和镇痛效果满意度。结果 Q组术后24 h镇痛泵按压次数、舒芬太尼总消耗量、氟比洛芬酯用量低于C组(P <0.05);两组术后即刻VAS评分没有显著差异(P> 0.05),术后2、4、6、12、24 h的VAS评分Q组均更低(P <0.05);Q组术后不良反应发生率低于C组(P <0.05);Q组镇痛效果满意度高于C组(P <0.05)。结论超声引导QLB能够减少腹腔镜肾切除患者术后阿片类药物用量,降低术后疼痛评分及不良反应发生率,提高患者术后舒适度和安全性。
Objective To evaluate the postoperative analgesic effect of ultrasound-guided quadratus lumborum block(QLB)after laparoscopic nephrectomy. Methods Sixty patients underwent laparoscopic nephrectomy were randomly divided into QLB group(group Q,0.4% ropivacaine hydrochloride 20 mL)and saline control group(group C). Patients were given PCIA after operation. If VAS over 4,50 mg flurbiprofen axetil was given intravenously. The number of analgesic pump press,the total amount of Sufentanil and Flurbiprofen axetil 24 h after operation were recorded between the two groups,as well as VAS of immediate postoperative period,and 2,4,6,12,24 h after operation;The postoperative adverse reactions and satisfaction score of patients in two groups were compared. Results The number of analgesic pump press,the total amount of Sufentanil and Flurbiprofen axetil in group Q were decreased(P < 0.05). VAS of immediate postoperative period had no difference between the groups(P > 0.05),VAS of 2,4,6,12,24 h after operation in group Q were lower than that in group C(P < 0.05);The incidence of postoperative adverse reactions in group Q was lower than that in group C(P < 0.05)and the satisfaction score of patients in group Q was higher than that in group C(P < 0.05). Conclusion Ultrasound-guided QLB can reduce the dosage of opioids after laparoscopic nephrectomy,reduce the postoperative pain score and the incidence of adverse reactions,and improve the postoperative comfort and safety of patients.
Objective To evaluate the postoperative analgesic effect of ultrasound-guided quadratus lumborum block(QLB)after laparoscopic nephrectomy. Methods Sixty patients underwent laparoscopic nephrectomy were randomly divided into QLB group(group Q,0.4% ropivacaine hydrochloride 20 mL)and saline control group(group C). Patients were given PCIA after operation. If VAS over 4,50 mg flurbiprofen axetil was given intravenously. The number of analgesic pump press,the total amount of Sufentanil and Flurbiprofen axetil 24 h after operation were recorded between the two groups,as well as VAS of immediate postoperative period,and 2,4,6,12,24 h after operation;The postoperative adverse reactions and satisfaction score of patients in two groups were compared. Results The number of analgesic pump press,the total amount of Sufentanil and Flurbiprofen axetil in group Q were decreased(P < 0.05). VAS of immediate postoperative period had no difference between the groups(P > 0.05),VAS of 2,4,6,12,24 h after operation in group Q were lower than that in group C(P < 0.05);The incidence of postoperative adverse reactions in group Q was lower than that in group C(P < 0.05)and the satisfaction score of patients in group Q was higher than that in group C(P < 0.05). Conclusion Ultrasound-guided QLB can reduce the dosage of opioids after laparoscopic nephrectomy,reduce the postoperative pain score and the incidence of adverse reactions,and improve the postoperative comfort and safety of patients.
引文
[1]黄辉虎,黄卫,王仕钦.经前腹腔镜与经后腹腔镜手术在萎缩无功能肾切除中的应用比较[J].实用医学杂志,2018,34(23):27-29.
[2] BLANCO R. TAP block under ultrasound guidance:The description of a‘no pops trechnique’[J]. Reg Anesth? Pain?Med,2007,32(5):130-133.
[3] AKERMAN M,PEJCIC N,VELICKOVIC I. A review of the quadratus lumborum block and ERAS[J]. Front Med(Lausanne),2018,5(44). doi:10.3389/fmed.2018.00044.
[4] KO A,HARADA M Y,SMITH E J,et al. Pain assessment and control in the injured elderly[J]. Am Surg,2016,82(10):867-871.
[5] YARUSHKINA N I,BAGAEVA T R,FILARETOVA L P. Involvement of corticotropin-releasing factor receptors type 2,located in periaquaductal gray matter,in central and peripheral CRF-induced analgesic effect on somatic pain sensitivity in rats[J]. J Physiol Pharmacol,2016,67(4):595-603.
[6] VUKOVIC N,DINIC L. Enhanced recovery after surgery protocols in major urologic surgery[J]. Front Med(Lausanne),2018,5(93). doi:10.3389/fmed.2018.00093.
[7] GELMAN D,GELMANAS A,URBANAITE D,et al. Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways[J]. Medicina(Kaunas),2018,54(2):20-44.
[8]贾倩倩,鲍丽娜.超声引导下腹横肌平面阻滞对小儿舒芬太尼静脉镇痛半数有效剂量的影响[J].实用医学杂志,2018,34(09):1533-1536.
[9]王健,盖殿秀,张建欣,等.超声引导下腰方肌阻滞用于腹腔镜妇科手术镇痛的效果评价[J].实用医药杂志,2018,35(5):410-412.
[10] KROHG A,ULLENSVANG K,ROSSELAND L A,et al. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery:A randomized clinical trial[J]. Anesthesia&Analgesia,2018,126(2):559-565.
[11] KILIC E,BULUT E. Quadratus lumborum blockⅢfor postoperative pain after percutaneous nephrolithotomy[J]. Turk J Anaesthesiol Reanim,2018,46(4):272-275.
[12] ELSHARKAWY H,EL-BOGHDADLY K,BARRINGTON M.Quadratus lumborum block:Anatomical concepts, mechanisms,and techniques[J]. Anesthesiology,2019,130(2):322-335.
[13] YANG H M,PARK S J,YOON K B,et al. Cadaveric evaluation of different approaches for quadratus lumborum blocks[J].Pain Res Manag,2018,2018:2368930.
[14] CARLINE L,MCLEOD G A,LAMB C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks[J]. Br J Anaesth,2016,117(3):387-394.
[15] KADAM V R. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy[J]. J Anaesthesiol Clin Pharmacol,2013,29(4):550-552.
[16] BLANCO R,ANSARI T,GIRGIS E. Quadratus lumborum block for postoperative pain after caesarean section:A randomised controlled trial[J]. Eur J Anaesthesiol,2015,32(11):812-818.
[17] 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[J].Reg Anesth Pain Med,2016,41(6):757-762.
[2] BLANCO R. TAP block under ultrasound guidance:The description of a‘no pops trechnique’[J]. Reg Anesth? Pain?Med,2007,32(5):130-133.
[3] AKERMAN M,PEJCIC N,VELICKOVIC I. A review of the quadratus lumborum block and ERAS[J]. Front Med(Lausanne),2018,5(44). doi:10.3389/fmed.2018.00044.
[4] KO A,HARADA M Y,SMITH E J,et al. Pain assessment and control in the injured elderly[J]. Am Surg,2016,82(10):867-871.
[5] YARUSHKINA N I,BAGAEVA T R,FILARETOVA L P. Involvement of corticotropin-releasing factor receptors type 2,located in periaquaductal gray matter,in central and peripheral CRF-induced analgesic effect on somatic pain sensitivity in rats[J]. J Physiol Pharmacol,2016,67(4):595-603.
[6] VUKOVIC N,DINIC L. Enhanced recovery after surgery protocols in major urologic surgery[J]. Front Med(Lausanne),2018,5(93). doi:10.3389/fmed.2018.00093.
[7] GELMAN D,GELMANAS A,URBANAITE D,et al. Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways[J]. Medicina(Kaunas),2018,54(2):20-44.
[8]贾倩倩,鲍丽娜.超声引导下腹横肌平面阻滞对小儿舒芬太尼静脉镇痛半数有效剂量的影响[J].实用医学杂志,2018,34(09):1533-1536.
[9]王健,盖殿秀,张建欣,等.超声引导下腰方肌阻滞用于腹腔镜妇科手术镇痛的效果评价[J].实用医药杂志,2018,35(5):410-412.
[10] KROHG A,ULLENSVANG K,ROSSELAND L A,et al. The analgesic effect of ultrasound-guided quadratus lumborum block after cesarean delivery:A randomized clinical trial[J]. Anesthesia&Analgesia,2018,126(2):559-565.
[11] KILIC E,BULUT E. Quadratus lumborum blockⅢfor postoperative pain after percutaneous nephrolithotomy[J]. Turk J Anaesthesiol Reanim,2018,46(4):272-275.
[12] ELSHARKAWY H,EL-BOGHDADLY K,BARRINGTON M.Quadratus lumborum block:Anatomical concepts, mechanisms,and techniques[J]. Anesthesiology,2019,130(2):322-335.
[13] YANG H M,PARK S J,YOON K B,et al. Cadaveric evaluation of different approaches for quadratus lumborum blocks[J].Pain Res Manag,2018,2018:2368930.
[14] CARLINE L,MCLEOD G A,LAMB C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks[J]. Br J Anaesth,2016,117(3):387-394.
[15] KADAM V R. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy[J]. J Anaesthesiol Clin Pharmacol,2013,29(4):550-552.
[16] BLANCO R,ANSARI T,GIRGIS E. Quadratus lumborum block for postoperative pain after caesarean section:A randomised controlled trial[J]. Eur J Anaesthesiol,2015,32(11):812-818.
[17] 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[J].Reg Anesth Pain Med,2016,41(6):757-762.