Department of Anesthesiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.
Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.
Trials. 2021 Nov 24;22(1):840. doi: 10.1186/s13063-021-05815-3.
Recently, several case reports and limited randomized studies have shown that quadratus lumborum blocks (QLB) are effective in providing pain relief after intra-abdominal and retroperitoneal operations. Additionally, robot-assisted partial nephrectomy (RAPN) has been proposed as a promising operative treatment for renal carcinoma because it enables early recovery and ambulation. Therefore, we aimed to evaluate the analgesic and opioid-sparing effects of a single-injection QLB in patients undergoing RAPN to determine its role in an early recovery program.
Fifty-six patients undergoing elective RAPN under general anesthesia were randomized to two equally sized groups. Patients were randomly allocated to receive either a unilateral QLB (n = 28) with 0.375% bupivacaine 0.5 mL/kg (QLB group) or a conventional scheme (n = 28) (control group). The QLB technique, termed QLB2, was performed as first described by Blanco. The primary outcome was visual analog scale (VAS) scores with movement at 6 h postoperatively. The secondary endpoints were morphine consumption at different time periods after surgery, morphine-related side effects, and assessment of postoperative rehabilitation.
Both the VAS pain scores and cumulative opioid consumption were significantly lower in the QLB group at 6 h after surgery as compared with results in the control group (all P < 0.05). There were significant differences in pain scores at all time points except at 4 h with movement and 48 h at rest. However, at 12-24 h no significant differences between the two groups were observed in cumulative opioid consumption or in the duration of PACU and hospital stays. The patient recovery scores were significantly higher in the QLB group.
Single-injection pre-emptive QLB applied to RAPN was effective and provided satisfactory analgesia and opioid-sparing effects in combination with typical patient-controlled analgesia. In addition, it may provide an effective technique for early recovery in the perioperative period for RAPN.
最近，一些病例报告和有限的随机研究表明，竖脊肌阻滞（QLB）在腹腔内和腹膜后手术后缓解疼痛是有效的。此外，机器人辅助部分肾切除术（RAPN）已被提出作为治疗肾癌的一种有前途的手术治疗方法，因为它可以实现早期恢复和活动。因此，我们旨在评估单次注射 QLB 在接受 RAPN 的患者中的镇痛和阿片类药物节省效果，以确定其在早期恢复计划中的作用。
56 例行全身麻醉下择期 RAPN 的患者被随机分为两组。患者随机分配接受单侧 QLB（n = 28），0.375%布比卡因 0.5 mL/kg（QLB 组）或常规方案（n = 28）（对照组）。QLB 技术，称为 QLB2，是由 Blanco 首次描述的。主要结局是术后 6 小时时的视觉模拟评分（VAS）。次要终点是手术后不同时间的吗啡消耗量、吗啡相关副作用以及术后康复评估。
与对照组相比，QLB 组术后 6 小时时 VAS 疼痛评分和累积阿片类药物消耗均显著降低（均 P < 0.05）。除运动时 4 小时和休息时 48 小时外，所有时间点的疼痛评分均有显著差异。然而，在 12-24 小时时，两组在累积阿片类药物消耗或 PACU 和住院时间方面无显著差异。QLB 组患者恢复评分明显更高。
预防性单次注射 QLB 应用于 RAPN 是有效的，并与典型的患者自控镇痛相结合提供了令人满意的镇痛和阿片类药物节省效果。此外，它可能为 RAPN 围手术期的早期恢复提供一种有效的技术。
