Kang Wenbin, Lu Dihan, Yang Xiaoyu, Zhou Zhibin, Chen Xi, Chen Keyu, Zhou Xue, Feng Xia
Department of Anesthesiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, People's Republic of China.
Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.
J Pain Res. 2019 Jul 25;12:2305-2312. doi: 10.2147/JPR.S202772. eCollection 2019.
Quadratus lumborum block (QLB) is shown to be effective on analgesia following cesarean section. This study aimed to compare the effects of three practical QLB approaches and classic epidural analgesia (EA) for cesarean section under spinal anesthesia.
Parturients undergoing elective cesarean section were randomized as group 1 (QLB type 2), group 2 (QLB type 3), group 3 (QLB type 2+3) and group 4 (EA). The block was performed at the end of the operation, and the epidural group was given a single epidural bolus. All subjects were provided with intravenous patient-controlled analgesia under identical settings. In addition, the postoperative pain severity was assessed by the VAS, which together with the morphine consumption at specific time intervals, was recorded within 48 hrs after surgery. Data were collected from December 2017 to June 2018.
A total of 94 parturients had completed the study. At almost all postoperative time points, the VAS scores at rest and with movement in QLB type 2+3 group were lower than those in QLB type 2 or 3 group. The mean additional morphine consumption in QLB type 2+3 group (2.7 mg) was lower than that in QLB type 2 or 3 group (6.1 mg and 5.7 mg, respectively) within 48 h after surgery (<0.001). Besides, the total morphine consumption in EA group (1.3 mg) was lower than that in any other QLB group (<0.001).
The analgesic effect of QLB is highly dependent on the injection position of local anesthetic. Besides, the ultrasound-guided QLB type 2+3 can provide superior analgesic effect following cesarean section to that of QLB type 2 or 3 block. However, it remains to be further validated about whether the combination of QLB type 2 and 3 is the best approach.
已证实腰方肌阻滞（QLB）对剖宫产术后镇痛有效。本研究旨在比较三种实用的QLB方法与经典硬膜外镇痛（EA）用于腰麻下剖宫产的效果。
择期剖宫产的产妇被随机分为1组（2型QLB）、2组（3型QLB）、3组（2 + 3型QLB）和4组（EA）。阻滞在手术结束时进行，硬膜外组给予单次硬膜外推注。所有受试者在相同设置下接受静脉自控镇痛。此外，通过视觉模拟评分法（VAS）评估术后疼痛严重程度，并记录术后48小时内特定时间间隔的吗啡消耗量。数据收集于2017年12月至2018年6月。
共有94名产妇完成了研究。在几乎所有术后时间点，2 + 3型QLB组静息和活动时的VAS评分均低于2型或3型QLB组。术后48小时内，2 + 3型QLB组的平均额外吗啡消耗量（2.7毫克）低于2型或3型QLB组（分别为6.1毫克和5.7毫克）（<0.001）。此外，EA组的总吗啡消耗量（1.3毫克）低于任何其他QLB组（<0.001）。
QLB的镇痛效果高度依赖于局麻药的注射位置。此外，超声引导下的2 + 3型QLB在剖宫产术后能提供优于2型或3型阻滞的镇痛效果。然而，2型和3型QLB联合是否为最佳方法仍有待进一步验证。
