双侧腰方肌后支阻滞用于剖宫产术后镇痛：一项随机对照试验。
Bilateral posterior Quadratus Lumborum block for pain relief after cesarean delivery: a randomized controlled trial.
机构信息
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Department of Anesthesiology, Police General Hospital, Bangkok, Thailand.
出版信息
BMC Anesthesiol. 2021 Mar 25;21(1):90. doi: 10.1186/s12871-021-01309-6.
BACKGROUND
Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB.
METHODS
Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared.
RESULTS
Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period was significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04-3.96) in Group IT vs. 7.75 (5.67-9.83) in IT+QLB vs. 1.75 (0.75-2.75) in QLB (p < 0.001)]. The median (min, max) amount of morphine required during 24 h was 5.5 (0-25) in Group IT vs. 5.0 (0-36) in IT+QLB vs. 17.5 (1-40) mg in Group QLB (p < 0.001). In the final analysis the median pain-free period was 2.50 (1.23-3.77) hours (95%CI) in Group IT (n = 27) vs. 8.02 (5.96-10.07) in IT+QLB (n = 28). (p = 0.027).
CONCLUSION
US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB could provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period.
TRIAL REGISTRATION
ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.
背景
实现剖宫产术后的最佳镇痛效果和最小副作用是疼痛管理的目标。鞘内（IT）吗啡是目前的标准治疗方法，但超声引导下竖脊肌间隙阻滞（QLB）可能具有更好的镇痛效果，副作用更少。本研究比较了接受 IT 吗啡脊髓阻滞、IT 吗啡加双侧 QLB 或单纯双侧 QLB 的产妇的剖宫产术后无疼痛期。
方法
选择择期行椎管内阻滞剖宫产的产妇，随机分为 IT 吗啡 0.2mg 加假 QLB 组（IT 组）、IT 吗啡 0.2mg 加双侧 QLB 组（IT+QLB 组）或双侧 QLB 组（QLB 组），每组 27 例。QLB 或假阻滞完成后连接 PCA 泵。记录并比较首次 PCA 吗啡需求时间。
结果
共纳入 80 例产妇。QLB 组分析提前终止，因为第二次中期分析显示，QLB 组的无疼痛期明显短于 IT+QLB 组[小时（95%CI）：2.50（1.04-3.96）与 IT 组相比，7.75（5.67-9.83）与 IT+QLB 组相比，1.75（0.75-2.75）与 QLB 组相比（p<0.001）]。24 小时内吗啡需求量中位数（最小，最大）分别为 5.5（0-25）mg 与 IT 组相比，5.0（0-36）mg 与 IT+QLB 组相比，17.5（1-40）mg 与 QLB 组相比（p<0.001）。最终分析显示，IT 组的无疼痛期中位数为 2.50（1.23-3.77）小时（95%CI）（n=27），与 IT+QLB 组的 8.02（5.96-10.07）小时相比（n=28）。（p=0.027）。
结论
与标准 IT 吗啡单独使用相比，超声引导下 QLB 与 IT 吗啡联合应用可显著延长中位无疼痛期。然而，单纯 QLB 与标准 IT 吗啡相比，疼痛控制效果较差。当与 IT 吗啡联合使用时，QLB 可作为多模式镇痛方案的一部分提供额外的镇痛益处，特别是在术后早期。
试验注册
ClinicalTrials.gov 编号 NCT03199170，注册日期为 2017 年 6 月 22 日。前瞻性注册。
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