Department of Anesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark.
Department of Anesthesiology, Aarhus Universitetshospital, Aarhus, Denmark.
Reg Anesth Pain Med. 2021 Jan;46(1):25-30. doi: 10.1136/rapm-2020-101931. Epub 2020 Oct 20.
The population of patients scheduled for total laparoscopic hysterectomy at our surgical center is heterogeneous concerning a multitude of demographic variables such as age, collateral surgery and malign or benign pathogenesis. A common denominator is moderate to severe postoperative pain and a substantial opioid consumption. A recent procedure specific postoperative pain management (PROSPECT) review found no gain from the regional techniques included. The transmuscular quadratus lumborum (TQL) block has shown promising results in recent trials for other types of surgery. The aim of the current study was to investigate the analgesic efficacy of the ultrasound-guided TQL block for total laparoscopic hysterectomy.
We enrolled 70 patients and randomly allocated participants to preoperative bilateral ultrasound-guided TQL block with either 60 mL 0.375% ropivacaine or 60 mL isotonic saline. Preoperatively, all patients received the TQL block (active or placebo) as well as a standardized multimodal analgesic regimen consisting of oral paracetamol, ibuprofen and dexamethasone. Intraoperatively, intravenous sufentanil 0.2 µg/kg was administered 30 min prior to emergence.
Opioid consumption during the first 12 postoperative hours.
Pain scores, times to first opioid demand and first ambulation, nausea and vomiting, and total opioid consumption during the first 24 postoperative hours.
No significant intergroup differences were observed for any outcome. Mean (SD) oral morphine equivalent consumption the first 12 postoperative hours was 58.4 mg (48.3) vs 62.9 mg (48.5), p=0.70, for group ropivacaine versus group saline.
Preoperative bilateral ultrasound-guided TQL block did not reduce opioid consumption after total laparoscopic hysterectomy.
NCT03650998, EudraCT (2017-004593-34).
在我们的外科中心，接受全腹腔镜子宫切除术的患者人群在多种人口统计学变量方面存在异质性，例如年龄、合并手术以及恶性或良性发病机制。一个共同点是中重度术后疼痛和大量阿片类药物消耗。最近的一项特定于手术的术后疼痛管理（PROSPECT）审查发现，所包括的区域技术没有带来任何收益。在最近的其他类型手术的试验中，经肌四方形腰方肌（TQL）阻滞显示出有希望的结果。本研究旨在探讨超声引导 TQL 阻滞对全腹腔镜子宫切除术的镇痛效果。
我们招募了 70 名患者，并将参与者随机分配至术前双侧超声引导 TQL 阻滞，分别给予 60 mL 0.375%罗哌卡因或 60 mL 等渗盐水。术前所有患者均接受 TQL 阻滞（主动或安慰剂）以及包括口服对乙酰氨基酚、布洛芬和地塞米松的标准化多模式镇痛方案。术中，在苏醒前 30 分钟给予静脉注射舒芬太尼 0.2 µg/kg。
术后 12 小时内的阿片类药物消耗。
疼痛评分、首次阿片类药物需求和首次活动的时间、恶心和呕吐以及术后 24 小时内的总阿片类药物消耗。
任何结局均未观察到组间无显著差异。术后 12 小时内口服吗啡等效消耗量的均值（标准差）分别为罗哌卡因组 58.4 mg（48.3）和盐水组 62.9 mg（48.5），p=0.70。
全腹腔镜子宫切除术前双侧超声引导 TQL 阻滞不能减少术后阿片类药物的消耗。
NCT03650998，EudraCT（2017-004593-34）。
