Venkatraman Rajagopalan, Saravanan Ravi, Mohana Koka Vatsalya, Pushparani Anand
Department of Anaesthesiology, SRM Medical College Hospital and Research Institute, Chennai, Tami Nadu, India.
Indian J Anaesth. 2020 Dec;64(12):1007-1011. doi: 10.4103/ija.IJA_335_20. Epub 2020 Dec 12.
Quadratus lumborum block (QLB) is a novel anaesthetic technique for abdominal wall block providing excellent post-operative analgesia. The primary objective of this study was to evaluate the duration of post-operative analgesia with QLB in unilateral laparoscopic renal surgeries. The secondary objectives were to assess total morphine consumption during the first 24 h postoperatively and observe for complications.
Sixty patients undergoing unilateral laparoscopic renal surgeries were randomly divided into two groups, with patients receiving QLB (Group A) or no block (Group B) at the end of surgery. General anaesthesia was standardised in both the groups. The pain was assessed by a Visual Analogue Scale (VAS) of 1-10. The duration of analgesia was taken as time from extubation to VAS of ≥3. Morphine was administered in patient-controlled analgesia pump with a bolus of 1 mg and a lockout interval of 10 min (min). The total morphine consumption was recorded. The statistical analysis was performed with the Student's -test and Chi-square test.
The duration of post-operative analgesia was significantly prolonged in Group A (1288 ± 288.92 min) than Group B (138 ± 54.92 min). Morphine consumption was also less in Group A (3.1 ± 0.87 mg) than Group B (10.46 ± 1.8 mg). There was a significant difference in the VAS score from 16 to 20 h. No complications were recorded.
Ultrasound-guided QLB after laparoscopic renal surgery is safer to perform, effective with an increased post-operative duration of analgesia, reduces the consumption of opioids and is associated with fewer side effects.
腰方肌阻滞(QLB)是一种新型的腹壁阻滞麻醉技术,可提供出色的术后镇痛效果。本研究的主要目的是评估QLB在单侧腹腔镜肾手术中的术后镇痛持续时间。次要目的是评估术后24小时内的吗啡总消耗量并观察并发症。
60例行单侧腹腔镜肾手术的患者被随机分为两组,一组患者在手术结束时接受QLB(A组),另一组不进行阻滞(B组)。两组均采用标准化的全身麻醉。采用1-10的视觉模拟评分法(VAS)评估疼痛程度。镇痛持续时间为从拔管至VAS评分≥3的时间。使用患者自控镇痛泵给予吗啡,单次剂量为1mg,锁定时间间隔为10分钟。记录吗啡总消耗量。采用学生t检验和卡方检验进行统计学分析。
A组术后镇痛持续时间(1288±288.92分钟)明显长于B组(138±54.92分钟)。A组吗啡消耗量(3.1±0.87mg)也低于B组(10.46±1.8mg)。在术后16至20小时,VAS评分存在显著差异。未记录到并发症。
腹腔镜肾手术后超声引导下QLB操作更安全、有效,可延长术后镇痛时间,减少阿片类药物的消耗,且副作用较少。