Department of Anesthesiology and Reanimation, University of Medical Science, Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Department of Anesthesiology and Reanimation, Özel Çankaya Hospital, Barbaros, Ankara, Turkey.
Niger J Clin Pract. 2022 Sep;25(9):1457-1465. doi: 10.4103/njcp.njcp_1876_21.
Ultrasound-guided truncal nerve blocks are increasingly used for postoperative pain relief after abdominal surgery.
The aim of this prospective and randomized study was to compare posterior transversus abdominis plane block (pTAPB) with posterior quadratus lumborum block (pQLB) for postoperative analgesic efficacy in patients undergoing unilateral inguinal hernia surgery under general anesthesia (GA).
A total of 90 adult patients were randomized into 3 groups: group pTAPB (n = 30), group pQLB (n = 30), and group Control (n = 30). The patients in groups pQLB and pTAPB received a unilateral block using 20 ml of 0.25% bupivacaine after the induction of GA. Intravenous (IV) tramadol patient control group analgesia (PCA) and paracetamol were used in the postoperative period as a part of the multimodal analgesic regimen in both groups. Postoperative pain was assessed using a visual analog scale (VAS) during postoperative 24 h. Dexketoprofene was used as a rescue analgesic when VAS is >3. The primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesics and the amount of tramadol delivered by PCA. P <0.05 was considered statistically significant.
Mean VAS scores were significantly lower in the group pQLB than group pTAPB and group Control at all-time points (pQLB < pTAPB < Control; P < 0.001). Rescue analgesic was not required in group QLB. Rescue analgesic consumption, the number of bolus demand on PCA, and total PCA dose were highest in group Control and lowest in the pQLB group (Control > pTAPB > pQLB; P < 0.001).
It is concluded that both pQLB and pTAPB provided effective pain relief after unilateral inguinal hernia surgery. pQLB was superior to pTAPB due to lower pain scores and analgesic consumption.
超声引导下躯干神经阻滞在腹部手术后的术后镇痛中越来越多地被使用。
本前瞻性随机研究的目的是比较后路腹横肌平面阻滞（pTAPB）与后路竖脊肌平面阻滞（pQLB）在全身麻醉（GA）下单侧腹股沟疝手术后的术后镇痛效果。
共 90 例成年患者随机分为 3 组：pTAPB 组（n = 30）、pQLB 组（n = 30）和对照组（n = 30）。pQLB 组和 pTAPB 组患者在 GA 诱导后接受单侧阻滞，使用 20ml0.25%布比卡因。静脉（IV）曲马多患者自控镇痛（PCA）和对乙酰氨基酚在术后期间作为多模式镇痛方案的一部分在两组中使用。术后 24 小时内使用视觉模拟评分（VAS）评估术后疼痛。当 VAS > 3 时，使用地佐辛作为解救性镇痛药。主要观察指标为平均疼痛评分。次要观察指标为解救性镇痛药的消耗和 PCA 给予的曲马多的量。P < 0.05 被认为具有统计学意义。
在所有时间点，pQLB 组的平均 VAS 评分均显著低于 pTAPB 组和对照组（pQLB < pTAPB < 对照组；P < 0.001）。pQLB 组不需要解救性镇痛药。解救性镇痛药消耗、PCA 单次剂量需求次数和 PCA 总剂量最高的是对照组，最低的是 pQLB 组（对照组 > pTAPB > pQLB；P < 0.001）。
单侧腹股沟疝手术后，pQLB 和 pTAPB 均可有效缓解疼痛。pQLB 由于疼痛评分和镇痛消耗较低，因此优于 pTAPB。
