Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongi University School of Medicine, Shanghai, 200072, People's Republic of China.
Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, Shanghai, 200072, People's Republic of China.
BMC Anesthesiol. 2022 Jul 11;22(1):213. doi: 10.1186/s12871-022-01755-w.
This study aimed to investigate the effects of ultrasound-guided quadratus lumborum block (QLB) on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy.
A total of 80 patients undergoing radical prostatectomy were randomly divided into two groups: general anaesthesia with QLB (QLB group; n = 40) and general anaesthesia with sham QLB (normal saline [NS] group; n = 40). QLB or sham QLB was performed before the induction of anaesthesia. Sufentanil was intravenously administered for postoperative analgesia. The primary outcome was the pain score (measured using a numerical rating scale [NRS]) at different time points within 48 h postoperatively. Secondary outcomes included the cumulative dose of sufentanil within 48 h postoperatively, subjective comfort, grip strength, first time of exhaustion, first fluid intake time, time to get out of bed, length of postoperative hospital stay and overall satisfaction. The SPSS software, version 17.0, was used for all statistical analyses.
Postoperative NRS at rest was significantly lower at 2 h (1.7 ± 1.1 versus 3.0 ± 2.1), 4 h (1.8 ± 1.2 versus 4.1 ± 2.3), 6 h (1.9 ± 2 versus 4.4 ± 2) and 12 h (3.5 ± 2.3 versus 5 ± 3.3) and was also lower when coughing at 2 h (2.3 ± 1.1 versus 4 ± 2.1), 4 h (2.3 ± 1. 1 versus 4.3 ± 2) and 6 h (2.4 ± 1.1 versus 5.9 ± 2.3) in the QLB than that in the NS group. The cumulative dose of sufentanil was significantly lower in the QLB than that in the NS group at 4 h, 6 h, 12 h, 24 h and 48 h. The nausea score was significantly lower in the QLB group at 24 h postoperatively, and the first time of exhaustion and time to get out of bed were significantly shorter (P < 0.05). The overall satisfaction score was significantly higher in the QLB than in the NS group (4 ± 0.7 versus 2.6 ± 0.9).
Ultrasound-guided bilateral QLB can provide effective postoperative analgesia for patients undergoing radical prostatectomy, reduce the need for sufentanil, facilitate comfort and improve postoperative outcomes. QLB can be a good component of multimodal analgesia.
The clinical trial is registered in the Chinese Clinical Trial Registry (ChiCTR). Current Controlled Trials: ChiCTR1900022009 . the date of registration:2019/03/20.
本研究旨在探讨超声引导竖脊肌平面阻滞（QLB）对接受根治性前列腺切除术患者围手术期多模式镇痛和术后结局的影响。
80 例行根治性前列腺切除术的患者被随机分为两组：全身麻醉加 QLB（QLB 组；n=40）和全身麻醉加假 QLB（生理盐水 [NS] 组；n=40）。在麻醉诱导前进行 QLB 或假 QLB。术后静脉给予舒芬太尼进行镇痛。主要结局是术后 48 小时内不同时间点的疼痛评分（采用数字评分量表 [NRS] 测量）。次要结局包括术后 48 小时内舒芬太尼的累积剂量、主观舒适度、握力、第一次疲劳时间、第一次液体摄入时间、下床时间、术后住院时间和总体满意度。使用 SPSS 软件，版本 17.0，进行所有统计分析。
术后静息时 NRS 在 2 小时（1.7±1.1 与 3.0±2.1）、4 小时（1.8±1.2 与 4.1±2.3）、6 小时（1.9±2 与 4.4±2）和 12 小时（3.5±2.3 与 5.0±3.3）时显著降低，咳嗽时在 2 小时（2.3±1.1 与 4.0±2.1）、4 小时（2.3±1.1 与 4.3±2）和 6 小时（2.4±1.1 与 5.9±2.3）时也显著降低，QLB 组均低于 NS 组。4 小时、6 小时、12 小时、24 小时和 48 小时时，QLB 组舒芬太尼的累积剂量明显低于 NS 组。术后 24 小时时，QLB 组恶心评分显著降低，第一次疲劳时间和下床时间明显缩短（P<0.05）。QLB 组的总体满意度评分明显高于 NS 组（4±0.7 与 2.6±0.9）。
超声引导双侧 QLB 可为接受根治性前列腺切除术的患者提供有效的术后镇痛，减少舒芬太尼的需求，提高舒适度，改善术后结局。QLB 可以成为多模式镇痛的一个很好的组成部分。
临床试验在中国临床试验注册中心注册（ChiCTR）。当前对照试验：ChiCTR1900022009，注册日期：2019 年 3 月 20 日。
