Cairo University, Kasr Al Aini Hospital, Cairo, Egypt.
Cairo University, Kasr Al Aini Hospital, Cairo, Egypt.
Braz J Anesthesiol. 2021 Jul-Aug;71(4):367-375. doi: 10.1016/j.bjane.2021.01.009. Epub 2021 Mar 21.
Patients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications.
This was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20-60 years, with ASA I and II, and a body mass index ≤ 30kg.m who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n=16) received USG transmuscular QLB; Group B (n=16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n=16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30min and 1,2,4,6, and 12hours postoperatively. The time of first analgesic request was also recorded.
Intraoperative fentanyl consumption (μg) was significantly lower in Groups A and B (164.69±27.35 and 190.31±44.48, respectively) than in Group C (347.50±63.64) (p<0.001). Postoperatively, total pethidine consumption was significantly lower in Groups A and B than in Group C (85.31±6.68, 84.06±4.17mg, and 152.19±43.43mg, respectively) (p<0.001. Time to rescue analgesia was longer in Groups A and B than in Group C (138.75±52.39min, 202.50±72.25min, and 37.50±13.42min, respectively) (p<0.001). VAS score was significantly lower in Groups A and B than in Group C at 30min and 1, 2, 4, and 6hours postoperatively.
Transmuscular quadratus lumborum block and posterior transversus abdominis blocks were effective in providing perioperative analgesia in patients undergoing open nephrectomy. However, quadratus lumborum block provided superior analgesia.
接受开放性肾切除术的患者经历严重的围手术期疼痛，主要是由于几个肌肉的切开。腹壁阻滞被认为可以减轻疼痛而不会引起硬膜外相关的低血压。我们进行这项研究是为了比较单侧超声引导下经肌肉腰方肌阻滞和后横腹平面阻滞联合全身麻醉在术中及术后镇痛、血流动力学和术后并发症方面的差异。
这是一项在手术室进行的随机、双盲、对照试验。这项研究包括 48 名年龄在 20-60 岁之间、ASA I 和 II 级、体重指数≤30kg.m 的患者，计划行开放性肾切除术。在全身麻醉诱导后，48 名拟行肾切除术的患者被随机分配到以下三组之一：A 组（n=16）接受超声引导下经肌肉腰方肌阻滞；B 组（n=16）接受单侧超声引导下后横腹平面阻滞；C 组（n=16；对照组）未接受任何阻滞。麻醉诱导后、手术切口时和手术结束前每 15 分钟记录一次术中芬太尼用量和血流动力学（心率和平均动脉压（MAP））。术后即刻（30 分钟）、1、2、4、6 和 12 小时评估视觉模拟评分（VAS）。记录首次要求镇痛的时间。
A 组和 B 组（分别为 164.69±27.35μg 和 190.31±44.48μg）术中芬太尼用量（μg）明显低于 C 组（347.50±63.64μg）（p<0.001）。术后，A 组和 B 组的总哌替啶用量明显低于 C 组（85.31±6.68、84.06±4.17mg 和 152.19±43.43mg）（p<0.001）。A 组和 B 组的解救镇痛时间明显长于 C 组（138.75±52.39min、202.50±72.25min 和 37.50±13.42min）（p<0.001）。术后 30 分钟、1、2、4 和 6 小时，A 组和 B 组的 VAS 评分明显低于 C 组。
在接受开放性肾切除术的患者中，经肌肉腰方肌阻滞和后横腹平面阻滞均能有效提供围手术期镇痛。然而，腰方肌阻滞提供了更好的镇痛效果。
