Department of Anaesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Urology, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.
Br J Anaesth. 2019 Aug;123(2):e350-e358. doi: 10.1016/j.bja.2019.04.054. Epub 2019 May 30.
Percutaneous nephrolithotomy (PNL) is associated with severe postoperative pain. The current study aimed to investigate the analgesic efficacy of transmuscular quadratus lumborum (TQL) block for patients undergoing PNL surgery.
Sixty patients were enrolled in this single centre study. The multimodal analgesic regime consisted of oral paracetamol 1 g and i.v. dexamethasone 4 mg before surgery and i.v. sufentanil 0.25 μg kg 30 min before emergence. After operation, patients received paracetamol 1 g regularly at 6 h intervals. Subjects were allocated to receive a preoperative TQL block with either ropivacaine 0.75%, 30 ml (intervention) or saline 30 ml (control). Primary outcome was oral morphine equivalent (OME) consumption 0-6 h after surgery. Secondary outcomes were OME consumption up to 24 h, pain scores, time to first opioid, time to first ambulation, and hospital length of stay. Results were reported as mean (standard deviation) or median (inter-quartile range).
Morphine consumption was lower in the intervention group at 6 h after surgery (7.2 [8.7] vs 90.6 [69.9] mg OME, P<0.001) and at 24 h (54.0 [36.7] vs 126.2 [85.5] mg OME, P<0.001). Time to first opioid use was prolonged in the intervention group (678 [285-1020] vs 36 [19-55] min, P<0.0001). Both the time to ambulation (302 [238-475] vs 595 [345-925] min, P<0.004) and length of stay (2.0 [0.8] vs 3.0 [1.2] days, P≤0.001) were shorter in the intervention group.
This is the first blinded, RCT that confirms that unilateral TQL block reduces postoperative opioid consumption and hospital length of stay. Further study is required for confirmation and dose optimisation.
NCT02818140.
经皮肾镜碎石术（PNL）术后疼痛剧烈。本研究旨在探讨腹横肌平面（TQL）阻滞对接受 PNL 手术患者的镇痛效果。
本单中心研究纳入 60 例患者。多模式镇痛方案包括术前口服扑热息痛 1 g 和静脉注射地塞米松 4 mg，以及术毕前静脉注射舒芬太尼 0.25 μg/kg。术后，患者每 6 小时接受扑热息痛 1 g 常规治疗。患者被分配接受术前 TQL 阻滞，罗哌卡因 0.75%，30 ml（干预组）或生理盐水 30 ml（对照组）。主要结局为术后 0-6 小时口服吗啡等效物（OME）消耗量。次要结局为术后 24 小时内 OME 消耗量、疼痛评分、首次使用阿片类药物时间、首次下床时间和住院时间。结果以均值（标准差）或中位数（四分位间距）表示。
术后 6 小时，干预组吗啡消耗量低于对照组（7.2 [8.7] vs 90.6 [69.9] mg OME，P<0.001），术后 24 小时吗啡消耗量也低于对照组（54.0 [36.7] vs 126.2 [85.5] mg OME，P<0.001）。干预组首次使用阿片类药物的时间延长（678 [285-1020] vs 36 [19-55] min，P<0.0001）。干预组下床时间（302 [238-475] vs 595 [345-925] min，P<0.004）和住院时间（2.0 [0.8] vs 3.0 [1.2]天，P≤0.001）均较短。
这是首个证实单侧 TQL 阻滞可减少术后阿片类药物用量和缩短住院时间的盲法、RCT。还需要进一步研究以确认和优化剂量。
NCT02818140。
