Department of General Anesthesiology, Pain Management and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, OH, USA.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA.
J Anesth. 2019 Feb;33(1):148-154. doi: 10.1007/s00540-018-02605-1. Epub 2019 Jan 18.
In the case of open urological surgeries, analgesic coverage at mid thoracic dermatomal levels is required. As shown in cadaveric studies, the site of QL block injection is an important determinant of the extent of dye spread and presumably local anesthetic dermatomal coverage. In this case series, we evaluated dermatomal blockade and analgesic efficacy of a subcostal approach to anterior QL block following open urological surgeries. Twenty-two adult patients undergoing renal transplant surgery (60%) and open nephrectomy (40%) received unilateral ultrasound-guided subcostal anterior QL block with catheter insertion. Sensory level, pain score (numeric rating scale, NRS), local anesthetic consumption, and opioid consumption (morphine equivalent dose, MED) were assessed daily for 3 days. The block achieved sensory blockade between T6-7 and L1-2. The most frequently affected dermatomes were T8 -T12 and the number of blocked segments was 3 (mean 2.8). The median (interquartile range Q1, Q3) of NRS pain score was 3.7 (2.8-5.5), 3.3 (2.4-4.7), 2.9 (1.9-3.6), and 2.3 (1.0-4.2) on POD0, POD1, POD2, and POD3, respectively. Our preliminary data showed that the subcostal approach to anterior QL block provides appropriate thoracic dermatome level needed for analgesia following open urological surgical procedures between T6-7 and L1-2.
在开放性泌尿科手术中，需要在中胸皮节水平提供镇痛覆盖。正如尸体研究所示，QL 阻滞注射部位是染料扩散范围和局部麻醉皮节覆盖的重要决定因素。在本病例系列中，我们评估了经肋弓下入路行前路 QL 阻滞在开放性泌尿科手术后的皮节阻滞和镇痛效果。22 例接受肾移植手术（60%）和开放性肾切除术（40%）的成年患者接受了单侧超声引导下经肋弓下入路前路 QL 阻滞联合导管插入术。每天评估感觉水平、疼痛评分（数字评分量表，NRS）、局部麻醉药消耗和阿片类药物消耗（吗啡等效剂量，MED），持续 3 天。阻滞达到 T6-7 和 L1-2 之间的感觉阻滞。受影响最频繁的皮节是 T8-T12，阻滞的节段数为 3 个（平均 2.8 个）。NRS 疼痛评分的中位数（四分位数范围 Q1、Q3）分别为术后第 0 天 3.7（2.8-5.5）、术后第 1 天 3.3（2.4-4.7）、术后第 2 天 2.9（1.9-3.6）和术后第 3 天 2.3（1.0-4.2）。我们的初步数据表明，经肋弓下入路前路 QL 阻滞可在 T6-7 和 L1-2 之间为开放性泌尿科手术提供适当的胸皮节水平镇痛。
