超声引导下经竖脊肌肌间 quadratus lumborum 阻滞减少腹腔镜肝切除术后患者术后阿片类药物的消耗：一项三臂随机对照试验。

Ultrasound-guided transmuscular quadratus lumborum block reduced postoperative opioids consumptions in patients after laparoscopic hepatectomy: a three-arm randomized controlled trial.

机构信息

Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, 510630, Guangdong Province, China.

出版信息

BMC Anesthesiol. 2021 Feb 11;21(1):45. doi: 10.1186/s12871-021-01255-3.

DOI:10.1186/s12871-021-01255-3

PMID:33573598

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7877010/

Abstract

BACKGROUND

To investigate whether transmuscular quadratus lumborum block (TQLB) combined with oxycodone-based patient-controlled intravenous analgesia (PCIA) compared with sufentanil-based patient-controlled intravenous analgesia could reduce postoperative pain and opioid consumption in patients undergoing laparoscopic hepatectomy.

METHODS

Eighty patients undergoing laparoscopic hepatectomy surgery were randomly divided into Group S (Sufentanil for PCIA group), Group O (Oxycodone for PCIA group) and Group QO (transmuscular quadratus lumborum block + oxycodone for PCIA group). Primary outcome was Numerical Rating Scale (NRS) pain score when coughing at 6th hour after the operation. We summarized opioid consumption and recorded complications, opioid drug adverse reaction and analgesia satisfaction.

RESULTS

NRS pain scores were significantly lower in Group QO while patients coughing at 6th hour after the operation compared with Group S and Group O (median (interquartile range [IQR]):Group S vs. Group O vs. Group QO 4.0 [3.0, 5.0] vs. 4.0[3.0,5.0]vs.3.0 [2.0, 3.0], p < 0.05). Within 24 h after surgery, the bolus times of PCIA (patient controlled intravenous analgesia) in the QO group was reduced which was compared with the Group S and Group O (median (interquartile range [IQR]):Group S vs. Group O vs. Group QO 13.0 [10.3, 19.5] vs. 11.5 [7.8, 18.3]vs.6.5[3.5,12.0], p < 0.05). The proportion of patients in the three groups who required additional analgesia was ranked as Group QO < Group O < Group S(p < 0.05). The analgesic satisfaction of patients in Group QO was higher than the Group S (p = 0.001) and Group O (p = 0.012).

CONCLUSIONS

TQLB combined with oxycodone-based PCIA provided satisfactory postoperative analgesia and reduced oxycodone consumption in patients following laparoscopic hepatectomy.

TRIAL REGISTRATION

ChiCTR1900028467 (22/12/2019).

摘要

背景

为了探讨与舒芬太尼为基础的患者自控静脉镇痛（PCIA）相比，经腹直肌外侧肌间 quadratus lumborum 阻滞（TQLB）联合氧可酮为基础的 PCIA 是否能减少腹腔镜肝切除术患者的术后疼痛和阿片类药物的使用。

方法

80 例行腹腔镜肝切除术的患者随机分为 S 组（舒芬太尼 PCIA 组）、O 组（氧可酮 PCIA 组）和 QO 组（经腹直肌外侧肌间 quadratus lumborum 阻滞+氧可酮 PCIA 组）。主要观察指标为术后第 6 小时咳嗽时的数字评分量表（NRS）疼痛评分。我们总结了阿片类药物的使用情况，并记录了并发症、阿片类药物不良反应和镇痛满意度。

结果

与 S 组和 O 组相比，QO 组患者在术后第 6 小时咳嗽时的 NRS 疼痛评分明显较低（中位数（四分位距[IQR]）：S 组 vs. O 组 vs. QO 组 4.0[3.0，5.0] vs. 4.0[3.0，5.0] vs. 3.0[2.0，3.0]，p<0.05）。术后 24 小时内，QO 组患者 PCIA（患者自控静脉镇痛）的推注次数较 S 组和 O 组减少（中位数（IQR）：S 组 vs. O 组 vs. QO 组 13.0[10.3，19.5] vs. 11.5[7.8，18.3] vs. 6.5[3.5，12.0]，p<0.05）。三组中需要额外镇痛的患者比例依次为 QO 组<O 组<S 组（p<0.05）。QO 组患者的镇痛满意度高于 S 组（p=0.001）和 O 组（p=0.012）。