Hansen Christian K, Dam Mette, Steingrimsdottir Gudny E, Laier Gunnar Hellmund, Lebech Morten, Poulsen Troels Dirch, Chan Vincent W S, Wolmarans Morné, Bendtsen Thomas Fichtner, Børglum Jens
Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark.
Region Zealand, Sorø, Denmark.
Reg Anesth Pain Med. 2019 Jul 14. doi: 10.1136/rapm-2019-100540.
Elective cesarean section (ECS) can cause moderate to severe pain that often requires opioid administration. To enhance maternal recovery, and promote mother and baby interaction, it is important to reduce postoperative pain and opioid consumption. Various regional anesthesia techniques have been implemented to improve postoperative pain management following ECS. This study aimed to investigate the efficacy of bilateral ultrasound-guided transmuscular quadratus lumborum (TQL) block on reducing postoperative opioid consumption following ECS.
A randomized double-blind trial with concealed allocation was conducted in 72 parturients who received bilateral TQL block with either 30 mL ropivacaine 0.375% or saline. TQL block injectate was deposited in the interfascial plane between the quadratus lumborum and psoas major muscles, posterior to the transversalis fascia. Primary outcome was opioid consumption, which was recorded electronically. Pain scores and time to first opioid request were also evaluated.
Opioid consumption (oral morphine equivalents, OME) was significantly reduced in group ropivacaine (GRO) in the first 24 hours compared with group saline (65 mg OME vs 94 mg OME) with a mean difference of 29 mg OME; 95% CI 3 to 55, p<0.03. Time to first opioid request was significantly prolonged in GRO, p<0.003. Numerical rating scale pain scores were significantly lower in GRO in the first 6 hours after surgery, p<0.03.
Bilateral TQL block significantly reduced 24 hours' opioid consumption. Further, we observed significant prolongation in time to first opioid, and significant reduction of pain during the first 6 postoperative hours.
择期剖宫产（ECS）可导致中度至重度疼痛，通常需要使用阿片类药物。为促进产妇恢复并增进母婴互动，减轻术后疼痛和减少阿片类药物用量至关重要。已采用多种区域麻醉技术来改善ECS术后的疼痛管理。本研究旨在探讨双侧超声引导下经肌腰方肌（TQL）阻滞对减少ECS术后阿片类药物用量的疗效。
对72例产妇进行了一项采用隐蔽分组的随机双盲试验，这些产妇接受了30毫升0.375%罗哌卡因或生理盐水的双侧TQL阻滞。TQL阻滞注射液注入腰方肌和腰大肌之间、腹横筋膜后方的筋膜间隙。主要结局指标为阿片类药物用量，通过电子方式记录。还评估了疼痛评分和首次要求使用阿片类药物的时间。
与生理盐水组相比，罗哌卡因组（GRO）在术后24小时内的阿片类药物用量（口服吗啡当量，OME）显著减少（65毫克OME对94毫克OME），平均差异为29毫克OME；95%置信区间为3至55，p<0.03。GRO组首次要求使用阿片类药物的时间显著延长，p<0.003。术后前6小时，GRO组的数字评定量表疼痛评分显著更低，p<0.03。
双侧TQL阻滞显著减少了24小时的阿片类药物用量。此外，我们观察到首次使用阿片类药物的时间显著延长，且术后前6小时疼痛显著减轻。
