Anterior quadratus lumborum block at the lateral supra-arcuate ligament versus transmuscular quadratus lumborum block for postoperative analgesia in patients undergoing laparoscopic nephrectomy: A randomized controlled trial

Study objectiveThe analgesic efficacy of transmuscular quadratus lumborum block (TQLB) to decrease the need for opioid consumption after laparoscopic nephrectomy has been demonstrated in several studies. However, the effect of an anterior QLB approach at the lateral supra-arcuate ligament (QLB-LSAL) in this surgical context is unclear. Here, we aimed to compare postoperative analgesic effects of the two block approaches in laparoscopic nephrectomy.DesignA single-center, randomized controlled trial.SettingUniversity-affiliated tertiary care hospital.PatientsA total of 106 patients with American Society of Anesthesiologists (ASA) physical status of I–III scheduled to undergo elective laparoscopic nephrectomy under general anesthesia.InterventionsPatients were randomly allocated to receive preoperative TQLB or QLB-LSAL with 0.5% ropivacaine (25 mL). Postoperatively, patient-controlled analgesia with intravenous sufentanil was administered.MeasurementsThe primary outcome was postoperative intravenous morphine equivalent consumption within the first 24 h postoperatively. Secondary outcomes included pain scores, satisfaction scores, levels of sedation, and incidence of nausea or vomiting.Main resultsPatients who underwent preoperative QLB-LSAL used a significantly lower intravenous morphine equivalent dose than those who underwent preoperative TQLB within the initial 24 h after surgery (34.3 ± 6.3 mg vs 23.5 ± 3.2 mg, P < 0.001). No significant differences were observed in pain scores, satisfaction scores, sedation scores, or incidence of nausea or vomiting between the groups.ConclusionsThe results indicate that, compared to TQLB, QLB-LSAL is a beneficial nerve block that can reduce postoperative opioid consumption, making it a potentially superior approach to achieve multimodal analgesia after laparoscopic nephrectomy.     

超声引导下低位前锯肌平面阻滞和腰方肌阻滞用于腹腔镜肾癌根治术的比较

目的比较超声引导下低位前锯肌平面阻滞(SAPB)和腰方肌阻滞(QLB)用于腹腔镜肾癌根治术的应用效果。方法选择行腹腔镜肾癌根治术患者90例,男55例,女35例,年龄18～80岁,BMI 19～28 kg/m~2,ASAⅠ或Ⅱ级。将患者随机分为三组:SAPB联合全麻组(S组)、QLB联合全麻组(Q组)和单纯全麻组(G组),每组30例。记录神经阻滞操作时间、神经阻滞起效时间、神经阻滞范围、神经阻滞相关并发症发生情况。记录术后0.5、2、12、24、48 h静息和活动时VAS疼痛评分。记录术中丙泊酚和瑞芬太尼用量、补救镇痛例数、术后48 h内镇痛泵按压次数及患者镇痛满意度评分。结果 S组阻滞操作时间和阻滞起效时间明显短于Q组(P0.05)。术后0.5、2、12、24 h S组和Q组静息和活动时VAS疼痛评分以及术后48 h活动时VAS疼痛评分明显低于G组(P0.05)。S组和Q组术中丙泊酚和瑞芬太尼用量明显少于G组(P0.05),补救镇痛率明显低于G组(P0.05),镇痛泵按压次数明显少于G组(P0.05),镇痛满意度评分明显高于G组(P0.05)。S组阻滞平面集中在T_6—T_(11),Q组阻滞平面集中在T_7—L_1。结论低位SAPB和QLB均可有效缓解腹腔镜肾癌根治术患者术后早期切口痛,减少术中全麻药物用量以及术后镇痛药物用量。与QLB比较,低位SAPB操作更简单、起效时间短,适宜在临床推广应用。     

Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery

Study objectiveThis study aimed to determine the efficacy of ultrasound-guided posterior quadratus lumborum block (QLB) in treating postoperative pain following laparoscopic gynecologic surgery.DesignProspective randomized controlled study.PatientsSeventy adult patients scheduled for elective laparoscopic gynaecological surgery under general anesthesia.InterventionThis randomized controlled study involved two groups of adult females who were scheduled to undergo laparoscopic gynecologic surgery under general anesthesia. Patients were randomly assigned to either the QLB group or Control group. In the QLB group, patients underwent posterior QLB with 20 mL of 0.375% ropivacaine on each side. Patients were blinded to treatment.MeasurementsAt 0, 1, 3, and 24 hours after anesthesia recovery, evaluator recorded the severity of postoperative pain in movement and at rest using a Numeric Rating Scale (NRS). We also evaluated the severity of nausea using NRS and number of additional analgesics.Main resultsImmediately after recovery from anesthesia, the NRS score for pain in movement did not differ significantly between groups. NRS scores for pain both in movement and at rest were significantly higher in the Control group than in the QLB group at 1, 3, and 24 h after recovery from anesthesia.ConclusionOur results suggest that posterior QLB significantly reduces postoperative pain in movement and at rest following laparoscopic gynecologic surgery.     

Posteromedial quadratus lumborum block versus transversus abdominal plane block for postoperative analgesia following laparoscopic colorectal surgery: A randomized controlled trial

Study objectiveOur hypothesis was that a pre-operative posteromedial quadratus lumborum (QL) block would reduce postoperative morphine consumption and provide superior analgesia in the setting of multimodal analgesia compared with a lateral transversus abdominis plane (TAP) block for laparoscopic colorectal surgery.DesignA randomized controlled study.SettingA single tertiary hospital. March to August 2018.Patients80 ASA I–II colorectal cancer patients undergoing laparoscopic radical resection were enrolled. 77 patients (group QL 38, group TAP 39) were included in the analysis.InterventionPre-operatively, patients were randomized to receive either a QL or TAP block (0.375% ropivacaine 20 ml bilaterally for each group).MeasurementsThe primary outcome was cumulative morphine consumption 24 h postoperatively. Secondary outcomes included postoperative pain scores, clinical recovery, and side-effect profiles of the blocks.Main resultsFor the primary outcome measure, morphine consumption 24 h postoperatively was significantly lower in the QL group than in the TAP group (estimated median difference −8 mg, adjusted 95% confidential interval −12 to −6 mg, P < 0.001). The pain visual analogue scores at rest and during movement were found to be statistically significantly lower in the QL group than in the TAP group 8, 12, and 24 h postoperatively (P < 0.006). The QL group reported higher overall satisfaction scores regarding postoperative analgesia than the TAP group (P = 0.014). One patient in the QL group experienced moderate back pain close to the needle entry site postoperatively. There was no statistically significant difference in postoperative nausea and vomiting, bowel recovery or length of hospital stay between the groups.ConclusionsThe pre-operative bilateral, ultrasound-guided posteromedial QL block reduces morphine consumption and improves analgesia in the setting of multimodal analgesia compared with the lateral TAP block after laparoscopic colorectal surgery.     

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。     

不同浓度罗哌卡因腰方肌阻滞用于腹腔镜手术患儿术后镇痛的效果

目的探讨超声引导下不同浓度罗哌卡因腰方肌阻滞用于患儿腹腔镜手术后镇痛的有效性和安全性。方法选择择期行腹腔镜疝囊和鞘状突高位结扎术患儿69例,男65例,女4例,年龄3～6岁,体重13～24 kg, ASAⅠ或Ⅱ级。采用随机数字表法将患儿分为三组:0.15%罗哌卡因组(C15组,n=23)、0.20%罗哌卡因组(C20组,n=22)和0.25%罗哌卡因组(C25组,n=24)。于手术切皮前行双侧腰方肌阻滞,三组分别注射0.15%、0.20%、0.25%罗哌卡因0.4 ml/kg。记录术后12 h内首次补救镇痛时间、需要补救镇痛例数,术后1、2、4、6、8、10、12 h的FACES评分及苏醒期躁动情况。记录术后穿刺部位血肿、感染、周围脏器损伤、局麻药毒性反应、下肢肌力减退、低血压等腰方肌阻滞相关并发症发生情况。结果 C25组术后12 h内首次补救镇痛时间明显晚于C15组(P0.05),需要补救镇痛例数明显少于C15组(P0.05)。术后1、2、4 h C25组FACES评分明显低于C15组和C20组(P0.05)。三组患儿苏醒期躁动发生率差异无统计学意义。所有患儿术后均未出现相关并发症。结论超声引导下0.25%罗哌卡因0.4 ml/kg双侧腰方肌阻滞可推迟腹腔镜疝囊和鞘状突高位结扎术患儿术后12 h内首次补救镇痛时间,且镇痛效果更好。     

腰方肌阻滞与肋缘下腹横肌平面阻滞在腹腔镜胃癌根治术后镇痛效果的比较

目的:比较超声引导下腰方肌阻滞（quadratus lumborum block, QLB）与肋缘下腹横肌平面阻滞（transverse abdominal plane block, TAPB）用于腹腔镜胃癌根治术的术后镇痛效果。方法:选择2021年1月至2021年7月择期在全身麻醉下行腹腔镜胃癌根治术的患者60例,采...     

超声引导下腰方肌阻滞与髂筋膜间隙阻滞在老年髋关节术后镇痛的比较

目的比较腰方肌阻滞(quadratus lumborum block,QLB)和髂筋膜间隙阻滞(fasciailiaca compartment block,FICB)在老年髋关节置换术的镇痛效果。方法选择择期拟行腰麻下全髋关节置换术的老年患者55例,男22例,女33例,年龄65～85岁,ASAⅠ或Ⅱ级,随机分为QLB组(n=28)和FICB组(n=27)。术后分别于超声引导下行QLB和FICB,予0.375%罗哌卡因30ml。所有患者术后行舒芬太尼静脉自控镇痛。记录术后6、12、24、48h镇痛泵按压次数及舒芬太尼用量;记录静息及运动时VAS疼痛评分;记录术后恶心呕吐、眩晕等不良反应情况。结果术后12、24、48h QLB组镇痛泵按压次数及舒芬太尼用量明显少于FICB组(P0.05);术后12、24、48hQLB组运动时VAS评分明显低于FICB组(P0.05),两组不同时点静息时VAS评分差异无统计学意义;QLB组恶心呕吐发生率明显低于FICB组[2(7.1%)vs 9(33.3%),P0.05]。结论腰方肌阻滞较髂筋膜间隙阻滞更能明显减轻髋关节置换术后活动痛,减少阿片类药物的使用及不良反应发生率。     

Posterior quadratus lumborum block versus epidural analgesia for postoperative pain management after open radical cystectomy: A randomized clinical trial

Background

In open abdominal surgery, continuous epidural analgesia is commonly used method for postoperative analgesia. However, ultrasound (US)-guided fascial plane blocks may be a reasonable alternative.

Methods

In this randomized controlled trial, we compared posterior quadratus lumborum block (QLB) with epidural analgesia for postoperative pain after open radical cystectomy (ORC). Adult patients aged 18–85 with bladder cancer (BC) scheduled for open RC were randomized in two groups. Exclusion criteria were complicated diabetes mellitus type I, lack of cooperation, and persistent pain for reasons other than BC. In one group, a bilateral US-guided single injection posterior QLB was performed with 3.75 mg/ml ropivacaine 20 ml/side. In the other group, continuous epidural analgesia with ropivacaine was used. Basic analgesia was oral paracetamol 1000 mg three times daily, and long-acting opioid twice daily in both groups. All patients had patient-controlled rescue analgesia with oxycodone. Postoperative cumulative rescue opioid consumption was recorded for the day of surgery, and the following 2 postoperative days (POD 0–2). Secondary outcomes were postoperative pain and nausea and vomiting.

Results

In total, 20 patients (QLB), and 19 patients (epidural analgesia) groups, were included in the analyses. Cumulative rescue opioid consumption on POD 0, being of duration 9–12 h, was 14 mg (7.6–33.3) in the QLB group versus 6.1 mg (2.0–16.1) in the epidural analgesia group, p = 0.089, and as doses, 8 doses (3.6–15.7) versus 4 doses (1.3–8.5), p = .057. On POD 1 consumption was 25.3 mg (11.0–52.9) versus 18.0 mg (14.4–43.7), p = .749, and as doses 12 (5.5–23.0) versus 10 (8–20), p > .9, respectively. On POD 2 consumption was 19.1 mg (7.9–31.0) versus 18.0 mg (5.4–27.6) p = .749, and as doses 8.5 (5.2–14.7) versus 11 (3.0–18.0) p > .9, respectively.

Conclusion

Opioid consumption did not differ significantly between posterior QLB and an epidural infusion with ropivacaine for the first 2 postoperative days following RC. Trial registration: ClinicalTrials.gov identifier NCT03328988.     

高位胸椎竖脊肌平面阻滞与臂丛上干阻滞在全身麻醉肩关节镜手术中应用的比较

目的 比较高位胸椎竖脊肌平面阻滞（high thoracic erector spinae plane block,HT-ESPB）与臂丛上干阻滞（superior trunk block,STB）在肩关节镜手术围手术期的镇痛效果。方法 纳入择期全身麻醉下行肩关节镜肩袖修补术病人共计60例,采用随机数字法将其分为HT-ESPB组（30例）与STB组（30例）。记录两组术中镇痛药物用量、拔管时间、膈肌阻滞发生率、相关并发症;术后2、6、12、24、48、72 h时静息和活动时的疼痛视觉模拟量表（VAS）评分,术后曲马多镇痛补救情况,病人术后镇痛满意度评分,术后24、48、72 h的15项恢复质量量表（QoR-15）评分以及不良反应发生情况。结果 HT-ESPB组术中舒芬太尼用量高于STB组［（21.5±11.1） μg vs. （15.6±10.3） μg,P=0.037］,术后曲马多用量高于STB组［（36.9±10.2） mg vs. （25.4±9.5） mg,P＜0.001］,膈神经阻滞发生率低于STB组（0 vs. 80%,P＜0.001）,术后24 h QoR-15评分显著高于STB组［（76.3±12.2）分 vs. （66.4±11.6）分,P=0.003］;两组病人静息和活动时VAS评分、镇痛满意度评分、并发症发生率差异无统计学意义（P＞0.05）。结论 肩关节镜手术中应用HT-ESPB能达到与STB类似的麻醉和镇痛效果,且膈神经阻滞发生率更低,尽管其镇痛药补救需求更多,仍是STB一种可行的替代方案。     

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.     

超声引导下髂筋膜联合腰方肌阻滞用于髋关节置换术后镇痛的效果

目的观察超声引导下髂筋膜联合腰方肌阻滞用于髋关节置换术后镇痛的效果。方法选择2017年3—12月拟行择期髋关节置换术患者60例,男26例,女34例,年龄55～75岁,体重45～70 kg,ASAⅠ或Ⅱ级。采用随机数字表法将患者随机分为两组:髂筋膜组(N组)和髂筋膜联合腰方肌组(T组),每组30例。T组术后行超声引导下髂筋膜联合腰方肌阻滞,各注射0.375%罗哌卡因15 ml。N组术后行超声引导下髂筋膜阻滞,注射0.375%罗哌卡因30 ml。术后两组均采用PCIA至术后48 h。记录阻滞操作前(T_0)、术后3 h(T_1)、6 h(T_2)、12 h(T_3)、24 h(T_4)、36 h(T_5)、48 h(T_6)时静息状态VAS评分以及T_4—T_6时运动状态VAS评分;记录阻滞后0～4 h、4～8 h、8～12 h、12～24 h、24～36 h、36～48 h各时段PCIA有效按压次数;记录T_3—T_6时术侧髋关节最大屈曲和外展活动度;记录术后不良反应。结果 T组T_1—T_6时静息状态VAS评分和T_4—T_6时运动状态VAS评分明显低于N组(P0.01)。阻滞后48 h内各时段T组PCIA有效按压次数明显少于N组(P0.01)。T组髋关节最大屈曲和外展活动度明显大于N组(P0.01)。T组术后恶心呕吐和尿储留发生率明显低于N组(P0.05)。结论超声引导下髂筋膜联合腰方肌阻滞用于髋关节置换术后镇痛效果显著,镇痛作用确切,不良反应发生率低。     

超声引导下罗哌卡因复合地塞米松腰方肌阻滞对全髋关节置换术患者术后镇痛的影响

目的 研究超声引导下腰方肌阻滞中罗哌卡因复合地塞米松对全髋关节置换术后镇痛的疗效.方法 选择2019年12月至2020年12月行全髋关节置换术的患者90例,男40例,女50例,年龄65～78岁,ASA Ⅰ或Ⅱ级.采用随机分组的方法分成罗哌卡因复合地塞米松组(D组),罗哌卡因组(Y组)和单纯静脉自控镇痛(PCIA)组(R...     

超声引导下单次竖脊肌平面阻滞用于老年患者术后镇痛的效果

目的观察超声引导下单次竖脊肌平面阻滞(ESP)用于胸腔镜手术老年患者术后镇痛的效果。方法选择本院择期行胸腔镜手术的老年患者80例,男49例,女31例,年龄65～77岁,BMI 20～24kg/m2,ASAⅠ或Ⅱ级。随机分为ESP联合静脉镇痛组(E组)和静脉镇痛组(C组),每组40例。E组于麻醉诱导前行0.33%罗哌卡因+地塞米松5mg混合液30ml单次竖脊肌平面阻滞,C组不予处理,两组患者均采用全身麻醉。记录患者术后1、6、12、24和48h的静息和咳嗽时VAS评分和舒适度(BCS)评分。记录镇痛泵有效按压次数、输注总量和曲马多给药次数,记录患者对术后镇痛的满意度,记录皮肤瘙痒、头晕、胸闷等不良反应情况和气胸、局麻药中毒、内脏损伤、全脊麻等ESP相关并发症发生情况。结果与C组比较,E组术中丙泊酚和瑞芬太尼用量明显减少(P0.05),不同时点静息和咳嗽时VAS评分明显降低(P0.05),BCS评分明显升高(P0.05),追加曲马多和镇痛泵有效按压次数明显减少(P0.05),满意度评分明显升高(P0.05)。两组皮肤瘙痒、头晕和胸闷等不良反应差异无统计学意义。两组患者均未见气胸、局麻药中毒、内脏损伤、全脊麻等ESP相关并发症。结论超声引导下单次竖脊肌平面阻滞可安全有效用于胸腔镜手术老年患者术后镇痛。