Murouchi Takeshi, Iwasaki Soshi, Yamakage Michiaki
From the Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Reg Anesth Pain Med. 2016 Mar-Apr;41(2):146-50. doi: 10.1097/AAP.0000000000000349.
The quadratus lumborum block (QLB) is an abdominal truncal block, similar to transversus abdominis plane block (TAPB). However, the characteristics of QLB with regard to its duration and safety are not well known. The primary aim of this study was to determine the block duration and the cutaneous sensory block area. Our secondary analysis included assessment of the chronological change in arterial local anesthetic concentrations after QLB.
This study included 11 patients scheduled for laparoscopic ovarian surgery under general anesthesia. The patients received bilateral single-injection QLBs (20 mL of 0.375% ropivacaine per side). Arterial blood was sampled at 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. The results were retrospectively compared with the results of our previous study on lateral TAPB.
The median duration of analgesia after QLB exceeded 24 hours and was significantly longer than the duration of lateral TAPB (P = 0.003). Quadratus lumborum block affected the T7-T12 dermatomes, whereas TAPB affected T10-T12. Arterial ropivacaine levels after block peaked at comparable time in the QLB and lateral TAPB groups (Tmax: 35 [SD, 13] vs 35 [SD, 11] minutes; P = 0.93). Peak ropivacaine concentrations were significantly lower in QLB than in lateral TAPB (Cmax: 1.0 [SD, 0.5] vs 1.8 [SD, 0.4] μg/mL; P = 0.0003).
Quadratus lumborum block resulted in a widespread and long-lasting analgesic effect after laparoscopic ovarian surgery and resulted in lower peak arterial ropivacaine concentrations as compared with those of lateral TAPB after 150 mg ropivacaine injection.
腰方肌阻滞（QLB）是一种腹部躯干阻滞，类似于腹横肌平面阻滞（TAPB）。然而，QLB在持续时间和安全性方面的特点尚不为人所知。本研究的主要目的是确定阻滞持续时间和皮肤感觉阻滞区域。我们的次要分析包括评估QLB后动脉局部麻醉药浓度的时间变化。
本研究纳入了11例计划在全身麻醉下进行腹腔镜卵巢手术的患者。患者接受双侧单次注射QLB（每侧20 mL 0.375%罗哌卡因）。在注射罗哌卡因后10、20、30、45、60、90和120分钟采集动脉血样。将结果与我们之前关于外侧TAPB的研究结果进行回顾性比较。
QLB后的中位镇痛持续时间超过24小时，明显长于外侧TAPB的持续时间（P = 0.003）。腰方肌阻滞影响T7 - T12皮节，而TAPB影响T10 - T12。QLB组和外侧TAPB组阻滞动脉罗哌卡因水平在可比时间达到峰值（Tmax：35 [标准差，13] 对35 [标准差，11] 分钟；P = 0.93）。QLB组罗哌卡因峰值浓度明显低于外侧TAPB组（Cmax：1.0 [标准差，0.5] 对1.8 [标准差，0.4] μg/mL；P = 0.0003）。
腰方肌阻滞在腹腔镜卵巢手术后产生广泛且持久的镇痛效果，与注射150 mg罗哌卡因后的外侧TAPB相比，动脉罗哌卡因峰值浓度更低。
