腰方肌阻滞在剖宫产术后镇痛中的临床应用

剖宫产是妇产科最常见的手术之一。围术期疼痛和镇痛药物对哺乳的影响是产妇焦虑的问题之一。目前,多模式镇痛策略已广泛用于剖宫产术后镇痛,其中腰方肌阻滞（QLB）是术后多模式镇痛的主要措施之一。QLB是将局麻药注射到腰方肌（QL）肌肉内或QL周围筋膜间隙的一种阻滞技术,是后腹壁肌肉之间的浅筋膜阻滞,可获得T10—T12阻滞范围,对剖宫产的切口痛和内脏痛均有良好的镇痛效果。QLB相对安全,但仍应警惕交感神经及脊神经阻滞、药物毒性、穿刺置管相关并发症。本文将围绕QLB在剖宫产术后镇痛中的临床应用进行综述。     

区域阻滞麻醉技术在髋关节手术中的应用进展

随着超声技术在麻醉领域中的广泛应用和对髋关节神经支配的深入认识,越来越多的区域阻滞麻醉技术用于髋关节手术患者的麻醉与镇痛。本文就腰丛阻滞(LPB)、髂筋膜间隙阻滞(FICB)、腰方肌阻滞(QLB)、竖脊肌平面阻滞(ESPB)和髋关节囊周神经(PENG)阻滞的解剖及入路、临床应用和并发症等方面等进行综述,以探讨各种区域阻滞麻醉技术在髋关节手术中的应用进展。     

腰方肌阻滞应用于剖宫产手术术后镇痛效果的系统评价

目的 系统评价腰方肌阻滞应用于剖宫产手术术后镇痛的有效性和安全性.方法计算机检索PubMed、The Cochrane Library、Embase、中国生物医学数据库(CBM)、万方数据库、中国知网和维普网数据库,收集从建库到2020年4月所有关于腰方肌阻滞用于剖宫产手术术后镇痛效果的随机对照试验.由两位评价员独立筛...     

超声引导腰方肌阻滞对全髋关节置换术后老年患者炎症应激和认知功能的影响

目的观察超声引导腰方肌阻滞镇痛在全髋关节置换术后的应用效果,探讨其对老年患者术后炎症应激和认知功能的影响。方法纳入自2018-01—2019-12完成的115例全髋关节置换术,观察组57例采用超声引导腰方肌阻滞进行镇痛,在超声引导下采用平面内技术将穿刺针由腰方肌入路置于腰方肌和腰大肌间的筋膜内,按1.25 mg/kg注入0.25%罗哌卡因,对照组58例仅注射生理盐水。结果 115例顺利完成手术并获得至少6个月随访。观察组术后48 h内镇痛泵按压次数、舒芬太尼用量少于对照组,术后6、12、24、48、72 h静息时与咳嗽时疼痛VAS评分均低于对照组,观察组术后24、72 h血清Cor、E、NE、CRP、IL-6、TNF-α水平低于对照组,观察组术后24、72 h的MMSE评分高于对照组,差异有统计学意义(P0.05)。结论超声引导腰方肌阻滞应用于老年全髋关节置换术后镇痛的效果良好,可减轻患者应激和炎症反应,改善术后认知功能,值得在临床推广应用。     

超声引导腰方肌与腹横平面阻滞用于腹股沟区手术患儿术后镇痛效果的比较

目的 比较超声引导腰方肌阻滞(QL)与腹横平面阻滞(TAP)用于腹股沟区手术患儿术后的镇痛效果.方法 择期喉罩全麻下行单侧腹股沟区手术的男性患儿60例.年龄4～8岁,ASA分级Ⅰ～Ⅱ.按随机数字表法分为QL组和TAP组,每组30例.喉罩置入后在超声引导下QL组行外侧入路腰方肌阻滞,TAP组行腹横平面阻滞,2组均应用0....     

腹腔镜下腹部手术应用腰方肌阻滞的效果评价

目的 评价超声引导腰方肌肌内阻滞用于腹腔镜下腹部手术的效果。方法 选择2022年1月至2023年1月在本院行腹腔镜下腹部手术患者60例,采用随机数字表法分为腰方肌肌内阻滞组（Q组）和切口局部浸润组（L组）,每组各30例。Q组术毕在超声引导下行双侧腰方肌肌内阻滞,每侧注射0.375%罗哌卡因20 mL;L组术毕实施切口局部浸润,注射0.375%罗哌卡因20 mL。术后每12 h静脉注射帕瑞昔布钠止痛。当患者VAS评分>3时,静脉注射曲马多补救镇痛。对比两组术后24 h曲马多累积用量、补救镇痛率、首次补救镇痛时间、术后VAS疼痛评分、患者满意度评分、恶心呕吐和其他不良反应发生情况。结果 与L组相比,Q组术后24 h曲马多累积用量较低（P<0.05）,术后6 h、12 h的补救镇痛率较低（P<0.05）,静息和活动VAS疼痛评分也显著较低（P<0.001）。Q组术后首次补救镇痛时间明显延长（P<0.001）。患者满意度、恶心呕吐发生率,两组差异无统计学意义（P>0.05）。两组均未发现下肢运动阻滞、局部血肿、局麻药中毒等并发症。结论 超声引导腰方肌肌内阻滞...     

超声引导下神经阻滞技术用于患儿腹部手术后镇痛的进展

区域神经阻滞是多模式镇痛的基础方案。与静脉镇痛比较,区域神经阻滞具有更强的针对性和有效性,神经阻滞麻醉镇痛可有效减少阿片类药物使用带来的不良反应。联合应用超声引导技术,能够提高神经阻滞的安全性和精确性。患儿腹部神经阻滞解剖结构以及局麻药物扩散途径、临床应用以及并发症的报道较少,药物浓度与剂量缺乏统一标准,需要进一步的临床研究。本文分别从患儿腰方肌阻滞（QLB）、腹横肌平面阻滞（TAPB）、腹直肌鞘阻滞（RSB）、竖脊肌平面阻滞（ESPB）和椎旁阻滞（PVB）的局麻药物扩散途径、浓度剂量、临床应用及相关并发症等方面进行综述,以期为患儿术后镇痛提供参考。     

区域阻滞在剖宫产术后镇痛的研究进展

随着加速康复外科理念的广泛普及,超声引导下行区域神经阻滞成为围手术期镇痛的有效方法之一,目前该方法已在剖宫产术后镇痛中广泛应用。文章通过查阅相关研究文献,对腹横肌平面阻滞（transversus abdominis plane block, TAPB）、腰方肌阻滞（quadratus lumborum block, Q...     

不同入路腰丛、坐骨神经阻滞用于下肢手术的比较

近年来，由于神经刺激器的应用、药物的改善、围手术期镇痛认识的更新，使得外周神经阻滞在下肢手术中应用越来越广泛，其中腰丛一坐骨神经联合阻滞更受到关注。腰丛阻滞主要有前路和后路，本研究旨在比较两者的临床效果。     

腰方肌阻滞在髋关节术后镇痛中的应用

髋关节手术创伤大,患者术后往往伴随中重度疼痛。安全且有效的术后镇痛可以有效促进患者的康复活动,有利于髋关节手术后患者早期功能恢复。常规使用的静脉自控镇痛虽然镇痛效果确切,但可能引起恶心呕吐、过度镇静、肠麻痹,甚至呼吸抑制等不良反应。腰方肌阻滞（QLB）作为一种替代腹横肌平面阻滞（TAPB）的技术。近年来逐渐应用于髋关节手术。本文通过对QLB的解剖基础、作用特点及其在髋关节手术中的应用作一综述,为QLB在髋关节术后镇痛中的应用提供参考。     

Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy

Quadratus lumborum block has recently been described as an effective and long‐lasting analgesic strategy for various abdominal operations, including gynaecological laparoscopy. Despite evidence that the analgesic effect is mediated by indirect paravertebral block and that local anaesthetic spreads to the lumbar paravertebral space, there have been no reports to date of lower limb motor weakness. We present a patient with unilateral hip flexion and knee extension weakness leading to unplanned overnight admission following lateral quadratus lumborum block with 20 ml levobupivacaine 0.25%. The L2 dermatomal sensory loss and hip flexion weakness suggested spread to either the L2 paravertebral space or to the lumbar plexus, causing weakness of the psoas and iliacus muscles and possibly the quadriceps. The duration of motor block was approximately 18 h. This complication should be considered when performing the block, especially in the setting of day‐case surgery.     

Hipotensão associada ao bloqueio bilateral do quadrado lombar realizado para analgesia pós‐operatória em caso de cirurgia aórtica aberta

Background and objectives

Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single‐shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post‐operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma.

Quadratus lumborum block for analgesia after caesarean section: a randomised controlled trial

Quadratus lumborum block has been shown to provide satisfactory analgesia after caesarean section performed under neuraxial anaesthesia. However, its efficacy has not been demonstrated in patients who have received intrathecal morphine. The aim of this study was to assess the efficacy of quadratus lumborum block as part of a multimodal analgesic regimen including intrathecal morphine. This was a prospective, double-blind, placebo-controlled trial. Participants were randomly allocated to receive bilateral quadratus lumborum block (40 ml levobupivacaine 0.25%) or sham block (control) after undergoing elective caesarean section under spinal anaesthesia. The primary outcome was 24-h morphine consumption measured by patient-controlled analgesia. Secondary outcomes included pain scores and quality of recovery. Data from 86 women were analysed. Median (IQR [range]) 24-h morphine consumption was similar in patients receiving quadratus lumborum block and sham block (12 (8–29 [0–68]) mg vs. 14 (5–25 [0–90]) mg, respectively; p = 0.986). There was a reduction in median (IQR [range]) visual analogue scale pain scores at 6 h with quadratus lumborum block compared with sham block both at rest (6 (0–14 [0–98]) mm vs. 14 (3–23 [0–64]) mm (p = 0.019); and on movement: 23 (10–51 [0–99]) mm vs. 44 (27–61 [2–94]) mm; (p = 0.014)). There was no difference in pain scores at any other time-point up to 48 h. When used in conjunction with intrathecal morphine and spinal anaesthesia, bilateral quadratus lumborum block does not reduce 24-h morphine consumption after caesarean section.     

Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis*

Caesarean delivery is the most commonly performed inpatient surgical procedure globally. Pain after caesarean delivery is moderate to severe if not adequately treated, and is a primary anaesthetic concern for patients. Transversus abdominis plane and quadratus lumborum blocks are fascial plane blocks that have the potential to improve analgesia following caesarean delivery. Although proponents of the quadratus lumborum block suggest that this technique may provide better analgesia compared with transversus abdominis plane block, there are limited data directly comparing these two techniques. We, therefore, performed a systematic review and network meta-analysis to compare transversus abdominis plane and quadratus lumborum block approaches, seeking randomised controlled trials comparing both techniques to each other, or to control, with or without intrathecal morphine. In all, 31 trials with 2188 patients were included and our primary outcome, the cumulative intravenous morphine equivalent consumption at 24 h, was reported in 12 trials. In the absence of intrathecal morphine, transversus abdominis plane and quadratus lumborum blocks were equivalent, and both were superior to control (moderate-quality evidence). In the presence of intrathecal morphine, no differences were found between control, transversus abdominis plane and quadratus lumborum blocks (moderate-quality evidence). Similar results were found for resting and active pain scores at 4–6 h, 8–12 h, 24 h and 36 h, although quadratus lumborum block was associated with lower pain scores at 36 h when compared with transversus abdominis plane block (very low-quality evidence). However, transversus abdominis plane block was associated with a reduced incidence of postoperative nausea and vomiting (moderate-quality evidence) and sedation when compared with inactive control following intrathecal morphine administration (low-quality evidence). There are insufficient data to draw definitive conclusions, but transversus abdominis plane and quadratus lumborum block appear to be superior to control in the absence of intrathecal morphine, but provide limited additional benefit over inactive control when intrathecal morphine is also used.     

O bloqueio contínuo do quadrado lombar tipo 3 fornece analgesia pós‐operatória efetiva para cirurgia do quadril: relato de caso

Introduction

Hip surgery is a major surgery that causes severe postoperative pain. Although pain during rest is usually considerably reduced mobilization is important in terms of thromboembolic complications. The quadratus lumborum block is a regional analgesic technique that blocks T6‐L3 nerve branches. This block may provide adequate analgesia and reduce opioid consumption after hip surgery.

Comparative efficacy of quadratus lumborum type-II and erector spinae plane block in patients undergoing caesarean section under spinal anaesthesia: a randomised controlled trial

BackgroundQuadratus lumborum and erector spinae plane blocks have been used to provide analgesia in patients undergoing thoracic or abdominal surgeries. Our study compared the analgesic efficacy of the quadratus lumborum type-II block (QLB-II) and the erector spinae plane block (ESPB) in parturients who underwent caesarean section under spinal anaesthesia.MethodsFifty-two patients with comparable demographic profiles were randomised into two groups, QLB-II (n = 26) and ESPB (n = 26). After the surgery, patients received either ultrasound-guided QLB-II or ESPB using 0.25% bupivacaine 0.3 mL/kg. Comparison of analgesic efficacy was in terms of fentanyl consumption (primary outcome), pain scores, incidence of complications in the 24-h postoperative period, and quality of recovery (QoR-15) on postoperative days one and two, and day of discharge.ResultsThere was no significant difference in cumulative number of fentanyl doses (W = 349.000, P = 0.840), numerical rating score at rest (P = 0.648) or with movement (P = 0.520), QoR-15 scores on postoperative day one (P = 0.549), day two (P = 0.927) or day of discharge (P = 0.676).ConclusionWe concluded that patients who underwent QLB-II or ESPB reported similar analgesic efficacy, complications, and quality of recovery in the postoperative period.     

Comparison of ultrasound-guided transmuscular quadratus lumborum block catheter technique with surgical pre-peritoneal catheter for postoperative analgesia in abdominal surgery: a randomised controlled trial

Following abdominal surgery, the provision of postoperative analgesia with local anaesthetic infusion through both transmuscular quadratus lumborum block and pre-peritoneal catheter have been described. This study compared these two methods of postoperative analgesia following laparotomy. Eighty-two patients 18–85 years of age scheduled to undergo elective surgery were randomly allocated to receive either transmuscular quadratus lumborum block or pre-peritoneal catheter block. In the transmuscular quadratus lumborum group, an 18-gauge Tuohy needle was passed through the quadratus lumborum muscle under ultrasound guidance to reach its anterior aspect. A 20-ml bolus of ropivacaine 0.375% was administered and catheters placed bilaterally. In the pre-peritoneal catheter group, 20 ml of ropivacaine 0.375% was infiltrated at each of three subcutaneous sub-fascial levels, and pre-peritoneal plane catheters were placed bilaterally. Both groups received an infusion of ropivacaine 0.2% at 5 ml.h⁻¹, continued up to 48 h along with a multimodal analgesic regime that included regular paracetamol and patient-controlled analgesia with fentanyl. The primary end-point was postoperative pain score on coughing, assessed using a numerical rating score (0–10). Secondary outcomes were pain score at rest, fentanyl usage until 48 h post-operation, satisfaction scores and costs. There was no treatment difference between the two groups for pain score on coughing (p = 0.24). In the transmuscular quadratus lumborum group, there was a reduction in numerical rating score at rest (p = 0.036) and satisfaction scores on days 1 and 30 (p = 0.004, p = 0.006, respectively), but fentanyl usage was similar. In the transmuscular quadratus lumborum group, the highest and lowest blocks observed in the recovery area were T4 and L1, respectively. The transmuscular quadratus lumborum technique cost 574.64 Australian dollars more per patient than the pre-peritoneal catheter technique.