后路竖脊肌平面阻滞与围手术期静脉注射利多卡因用于腹腔镜结直肠手术患者术后疼痛控制的前瞻性随机双盲对照临床试验。

Quadratus Lumborum Block Versus Perioperative Intravenous Lidocaine for Postoperative Pain Control in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial.

机构信息

Department of Anaesthesiology, University Hospitals of the KU Leuven, Leuven, Belgium.

Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.

出版信息

Ann Surg. 2018 Nov;268(5):769-775. doi: 10.1097/SLA.0000000000002888.

DOI:10.1097/SLA.0000000000002888

PMID:30004914

Abstract

OBJECTIVE

To investigate the comparative analgesic efficacy of systemic lidocaine and quadratus lumborum (QL) block in laparoscopic colorectal surgery.

BACKGROUND

Although epidural analgesia is the standard to control pain in patients undergoing open colorectal surgery, optimal analgesic management in laparoscopic surgery is less well-defined. There is need for effective and efficient alternatives to epidural analgesia for pain management in patients undergoing laparoscopic colorectal surgery.

METHODS

A total of 125 patients undergoing laparoscopic colorectal surgery were included in this randomized, double-blind controlled clinical trial. Patients randomly received an intravenous infusion with placebo plus a QL-block with placebo, a QL-block with ropivacaine 0.25% plus intravenous placebo, or intravenous lidocaine plus a QL-block with placebo. Postoperatively, all patients received patient-controlled intravenous anesthesia (PCIA) with morphine. Primary outcome parameter was the opioid consumption during the first 24 hours postoperatively. Secondary endpoints included severity of postoperative pain, time to return of intestinal function, incidence of postoperative nausea and vomiting, and length of hospital stay.

RESULTS

The QL-block was not superior to systemic lidocaine for the reduction of morphine requirements in the first 24 hours postoperatively {QL-group: 37.5 (28.4) mg [mean (standard deviation)] vs lidocaine group: 40.2 (25) mg, P = 0.15}. For the majority of secondary outcome parameters, no significant differences were found between the groups. Morphine consumption in the postanesthesia care unit, the number of PCIA-boli demanded by the patient, and the number of PCIA-boli delivered by the PCIA-pump during the first 24 hours postoperatively were lower in the placebo group.

CONCLUSIONS

In our trial, the QL-block did not provide superior postoperative analgesia when compared to systemic lidocaine in laparoscopic colorectal surgery.

TRIAL REGISTRATION

Eudra CT: 2014-001499-73; 31/7/2014.

摘要

目的

探究全身应用利多卡因与竖脊肌平面阻滞在腹腔镜结直肠手术中镇痛效果的比较。

背景

硬膜外镇痛是开腹结直肠手术患者控制疼痛的标准，但腹腔镜手术中最佳镇痛管理的定义尚不明确。对于接受腹腔镜结直肠手术的患者，需要寻找一种有效的、高效的硬膜外镇痛替代方法进行疼痛管理。

方法

本随机、双盲对照临床试验纳入了 125 例接受腹腔镜结直肠手术的患者。患者随机接受静脉输注安慰剂联合竖脊肌平面阻滞（阻滞部位注射安慰剂）、静脉输注利多卡因联合竖脊肌平面阻滞（阻滞部位注射罗哌卡因 0.25%）或静脉输注利多卡因联合竖脊肌平面阻滞（阻滞部位注射安慰剂）。术后，所有患者均接受吗啡自控静脉镇痛（PCIA）。主要结局参数为术后 24 小时内阿片类药物的消耗量。次要结局指标包括术后疼痛严重程度、肠道功能恢复时间、术后恶心呕吐发生率和住院时间。

结果

与全身应用利多卡因相比，竖脊肌平面阻滞并未降低术后 24 小时内吗啡的需求量[竖脊肌平面阻滞组：37.5（28.4）mg；利多卡因组：40.2（25）mg，P=0.15]。对于大多数次要结局指标，两组间无显著差异。术后恢复室中吗啡的消耗量、患者要求的 PCIA 按压次数以及术后 24 小时内 PCIA 泵输送的 PCIA 按压次数在安慰剂组中较低。