Singariya Geeta, Choudhary Sangeeta, Kamal Manoj, Seervi Satya Narayan, Bihani Pooja, Kumar Mritunjay
Department of Anaesthesiology and Critical Care, Dr S N Medical College, Jodhpur, Rajasthan, India.
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Indian J Anaesth. 2020 Aug;64(8):668-674. doi: 10.4103/ija.IJA_159_20. Epub 2020 Jul 31.
Quadratus lumborum block (QLB) provides somatic and visceral analgesia to the lower thoracic and abdominal wall. The aim was to investigate the analgesic effect of dexamethasone with levobupivacaine in QLB in patients undergoing unilateral inguinal hernia repair surgery.
A total of 90 patients of American Society of Anaesthesiologists (ASA) I/II were randomly divided into two groups. Group L received 0.25% levobupivacaine (20 ml) + normal saline (1 ml) and group D received 0.25% levobupivacaine (20 ml) + 4 mg dexamethasone (1 ml) in QL plane on the operated side using ultrasound, after completion of surgery under spinal anaesthesia. The primary objective was to compare time for first rescue analgesia. The secondary objectives were total rescue analgesic consumption and numeric rating scale (NRS) in the first 24 h.
The demographic data age, sex, height, weight and ASA were comparable in both groups. The mean time to request for first rescue analgesia was longer in group D compared to group L (1016.02 ± 205.97 min versus 640 ± 132.96 min; < 0.0001). The mean total tramadol consumption in the first 24 h was lower in group D compared to group L (233.55 ± 86.92 mg versus 328.22 ± 78.74 mg; < 0.0001). Patients in group D had significantly lower NRS scores at rest and on movement as compared to group L.
The addition of dexamethasone to levobupivacaine in QLB results in prolonged duration of postoperative analgesia, less rescue analgesic requirements and better quality of analgesia as compared to levobupivacaine in unilateral inguinal hernia repair surgery.
腰方肌阻滞（QLB）可为下胸壁和腹壁提供躯体及内脏镇痛。本研究旨在探讨地塞米松与左旋布比卡因用于单侧腹股沟疝修补手术患者QLB的镇痛效果。
将90例美国麻醉医师协会（ASA）分级为I/II级的患者随机分为两组。L组在脊髓麻醉下完成手术后，于手术侧QL平面接受0.25%左旋布比卡因（20 ml）+生理盐水（1 ml），D组接受0.25%左旋布比卡因（20 ml）+4 mg地塞米松（1 ml）。主要目标是比较首次补救镇痛时间。次要目标是前24小时的总补救镇痛药物消耗量及数字评分量表（NRS）评分。
两组患者的年龄、性别、身高、体重及ASA分级等人口统计学数据具有可比性。D组首次补救镇痛请求的平均时间长于L组（1016.02±205.97分钟对640±132.96分钟；<0.0001）。D组前24小时曲马多的平均总消耗量低于L组（233.55±86.92 mg对328.22±78.74 mg；<0.0001）。与L组相比，D组患者静息及活动时的NRS评分显著更低。
在单侧腹股沟疝修补手术中，QLB时在左旋布比卡因中添加地塞米松与单纯使用左旋布比卡因相比，可延长术后镇痛时间，减少补救镇痛需求，提高镇痛质量。
