Guo Min, Lei Bo, Li Huili, Gao Xiaoru, Zhang Tianshu, Liang Ziwei, Wang Yun, Wang Lei
Department of Anesthesiology, Beijing Haidian Maternal & Child Health Hospital, Beijing 100080, China.
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
J Clin Med. 2022 Jul 1;11(13):3827. doi: 10.3390/jcm11133827.
Several studies have shown the effectiveness of trans-muscular quadratus lumborum block (TQLB) in analgesia after cesarean delivery. However, the influence of anterior QLB at the lateral supra-arcuate ligament (QLB-LSAL) in this surgery is unclear. This study aimed to compare the analgesic efficacy of bilateral TQLBs with bilateral QLBs-LSAL following cesarean delivery. Ninety-four parturients scheduled for cesarean delivery under spinal anesthesia were enrolled and randomly allocated to undergo either bilateral TQLBs or bilateral QLBs-LSAL with 0.375% of ropivacaine (20 mL each side) following cesarean delivery. Intravenous sufentanil was administered for patient-controlled analgesia (PCA). The primary outcome was postoperative sufentanil consumption during the initial 24 h post-surgery. Secondary endpoints included pain scores, time to the first PCA request, postoperative rescue analgesia, satisfaction scores, and nausea/vomiting events. Sufentanil consumption was significantly reduced in the QLB-LSAL group in the first 24 h compared with the TQLB group after surgery (29.4 ± 5.7 μg vs. 39.4 ± 9.6 μg, p < 0.001). In comparison with TQLB, the time to the first PCA request in the QLB-LSAL group was significantly longer (10.9 ± 4.1 h vs. 6.7 ± 1.8 h, p < 0.001). No differences were observed between two groups regarding pain scores, rescue analgesia after surgery, satisfaction scores, or nausea/vomiting incidence. The significant reduction in opioid consumption in the first 24 h and prolongation in time to first opioid demand in parturients receiving QLB-LSAL compared with TQLB suggest that the QLB-LSAL is a superior choice for multimodal analgesia after cesarean delivery.
多项研究表明，经肌腰方肌阻滞（TQLB）在剖宫产术后镇痛中具有有效性。然而，在该手术中，外侧弓状韧带上方前路腰方肌阻滞（QLB-LSAL）的影响尚不清楚。本研究旨在比较剖宫产术后双侧TQLB与双侧QLB-LSAL的镇痛效果。94例计划在脊髓麻醉下进行剖宫产的产妇被纳入研究，并随机分配接受双侧TQLB或双侧QLB-LSAL，剖宫产术后每侧注射0.375%的罗哌卡因（20 mL）。静脉注射舒芬太尼用于患者自控镇痛（PCA）。主要结局是术后最初24小时内舒芬太尼的消耗量。次要终点包括疼痛评分、首次PCA请求时间、术后补救镇痛、满意度评分和恶心/呕吐事件。与TQLB组相比，QLB-LSAL组术后24小时内舒芬太尼消耗量显著降低（29.4±5.7μg对39.4±9.6μg，p<0.001）。与TQLB相比，QLB-LSAL组首次PCA请求时间显著延长（10.9±4.1小时对6.7±1.8小时，p<0.001）。两组在疼痛评分、术后补救镇痛、满意度评分或恶心/呕吐发生率方面未观察到差异。与TQLB相比，接受QLB-LSAL的产妇在术后24小时内阿片类药物消耗量显著降低，首次阿片类药物需求时间延长，这表明QLB-LSAL是剖宫产术后多模式镇痛的更佳选择。
