From the Departments of Anesthesia and Critical Care and Plastic and Reconstructive Surgery, Faculty of Medicine, Saint-Joseph University, Hotel-Dieu de France Hospital.
Plast Reconstr Surg. 2021 Apr 1;147(4):851-859. doi: 10.1097/PRS.0000000000007767.
Postoperative pain after abdominoplasty can delay postoperative ambulation, leading to life-threatening complications. Previous reports have shown the utility of quadratus lumborum block in providing adequate pain relief and avoiding side effects after numerous abdominal operations. The purpose of this randomized controlled trial was to demonstrate the efficacy of the quadratus lumborum block in abdominoplasty.
Patients were randomly allocated to receive a bilateral quadratus lumborum block with either ropivacaine or normal saline. Postoperative cumulative analgesic medication consumption, pain severity at rest and on movement, and quality of recovery were evaluated and compared in both groups.
Twenty patients were allocated to each group. Total morphine dose received in the postanesthesia care unit was lower in the ropivacaine group than in the control group, with a mean of 3.4 mg and 6.6 mg, respectively. Cumulative tramadol consumption per patient in the first 48 hours postoperatively was significantly lower in the ropivacaine group compared with the control group (42.5 mg versus 190 mg; p = 0.0031). The Numeric Rating Scale both at rest and with effort was significantly lower in the ropivacaine group compared with the control group. The median quality of recovery for the ropivacaine group was 133 compared with 112 for the control group (p < 0.0001).
Quadratus lumborum block in abdominoplasty reduces postoperative pain and opioid consumption and improves the quality of recovery. Further studies are needed to compare the quadratus lumborum block to more traditional blocks.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
腹壁整形术后疼痛会延迟术后活动，导致危及生命的并发症。先前的报告表明，竖脊肌阻滞在许多腹部手术后提供足够的疼痛缓解和避免副作用方面是有效的。本随机对照试验的目的是证明竖脊肌阻滞在腹壁整形术中的疗效。
患者被随机分配接受双侧竖脊肌阻滞，分别用罗哌卡因或生理盐水。在两组中评估和比较术后累积镇痛药的使用量、静息和运动时的疼痛严重程度以及恢复质量。
每组 20 名患者被分配。麻醉后护理病房接受的罗哌卡因组吗啡总剂量低于对照组，分别为 3.4 毫克和 6.6 毫克。术后 48 小时内，每例患者接受的曲马多累积用量在罗哌卡因组明显低于对照组（42.5 毫克比 190 毫克；p = 0.0031）。与对照组相比，罗哌卡因组的静息和用力时的数字评分量表（Numeric Rating Scale）明显较低。罗哌卡因组的恢复质量中位数为 133，而对照组为 112（p < 0.0001）。
腹壁整形术中的竖脊肌阻滞可减少术后疼痛和阿片类药物的使用，并提高恢复质量。需要进一步的研究来比较竖脊肌阻滞与更传统的阻滞。
临床问题/证据水平：治疗性，II 级。
