Ahuja Vanita, Thapa Deepak, Nandi Souvik, Gombar Satinder, Dalal Ashwani, Bansiwal Rajesh Kumar
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
Department of General Surgery, Government Medical College and Hospital, Chandigarh, India.
Indian J Anaesth. 2020 Aug;64(Suppl 3):S198-S204. doi: 10.4103/ija.IJA_545_20. Epub 2020 Aug 15.
An ultrasound-guided quadratus lumborum (QL) block provides both somatic and visceral analgesia in abdominal surgeries. We aimed to evaluate the postoperative tramadol sparing effect of single-shot anterior QL block in inguinal hernia surgery patients.
This prospective, randomised controlled trial was conducted in a single tertiary care centre over a period of 1 year. A total of 50 patients, American Society of Anaesthesiologists (ASA) physical status I-II of both sexes aged 18-80 years with body mass index (BMI) ≥20 to ≤35 kg/m undergoing uncomplicated unilateral inguinal hernia surgery under spinal anaesthesia (SA) were randomly allocated to either of the two groups. The block group ( = 25) received single-shot anterior QL block with 20 ml of 0.5% ropivacaine and the control group ( = 25) received no block. Postoperatively, patients received intravenous (IV) paracetamol 1g every 6 h and tramadol patient-controlled analgesia up to 24 h. Primary outcome was total tramadol consumption at 24 h postoperatively.
The total tramadol consumption mean ± SD [95% CI (range)] at 24 h in the block group was 84.00 ± 37.86 [68.37-99.63 (20-160)] mg versus 93.60 ± 34.99 [79.16-108.04 (20-160)] mg in control group, (p value = 0.36). Postoperative VAS score, haemodynamics, and patient satisfaction score were similar in both the groups. No adverse events were reported.
A single-shot anterior QL block did not establish a postoperative tramadol-sparing effect at 24 h as compared to no block in patients undergoing inguinal hernia surgery under SA.
超声引导下腰方肌（QL）阻滞可为腹部手术提供躯体和内脏镇痛。我们旨在评估单次前路QL阻滞对腹股沟疝手术患者术后曲马多节省效应。
本前瞻性随机对照试验在一家三级医疗中心进行，为期1年。共有50例年龄在18 - 80岁、美国麻醉医师协会（ASA）身体状况为I - II级、体重指数（BMI）≥20至≤35 kg/m²、在蛛网膜下腔麻醉（SA）下行单纯性单侧腹股沟疝手术的患者，随机分为两组。阻滞组（n = 25）接受20 ml 0.5%罗哌卡因的单次前路QL阻滞，对照组（n = 25）不接受阻滞。术后，患者每6小时静脉注射（IV）1g对乙酰氨基酚，并接受曲马多患者自控镇痛，持续24小时。主要结局是术后24小时曲马多的总消耗量。
阻滞组术后24小时曲马多总消耗量均值±标准差[95%置信区间（范围）]为84.00 ± 37.86 [68.37 - 99.63（20 - 160）]mg，而对照组为93.60 ± 34.99 [79.16 - 108.04（20 - 160）]mg，（p值 = 0.36）。两组术后视觉模拟评分（VAS）、血流动力学和患者满意度评分相似。未报告不良事件。
与SA下腹股沟疝手术未接受阻滞的患者相比，单次前路QL阻滞在术后24小时未显示出曲马多节省效应。
