Tanggaard Katrine, Hasselager Rune Petring, Hølmich Emma Rosenkrantz, Hansen Christian, Dam Mette, Poulsen Troels Dirch, Bærentzen Finn Østergård, Eriksen Jens Ravn, Gögenur Ismail, Børglum Jens
Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Denmark.
Department of General Surgery, Zealand University Hospital Koge, Koge, Denmark.
Reg Anesth Pain Med. 2023 Jan;48(1):7-13. doi: 10.1136/rapm-2022-103895. Epub 2022 Sep 27.
An opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery.
In this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events.
The total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences.
The administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery. NCT03570541.
腹腔镜半结肠切除术后采用减少阿片类药物用量的镇痛方案，对于减轻术后疼痛、促进早期活动及改善恢复质量最为理想。为改善腹腔镜半结肠切除术后的疼痛管理，已对多种区域麻醉技术进行了测试。在本研究中，我们旨在评估术前双侧超声引导下腰方肌前侧神经阻滞对腹腔镜结肠癌手术后阿片类药物用量的影响。
在这项随机、对照、双盲试验中，69例因结肠癌接受腹腔镜半结肠切除术的患者被随机分为两组，分别接受每侧30 mL 0.375%罗哌卡因的腰方肌前侧阻滞或等渗盐水（安慰剂）。主要结局指标为术后24小时内阿片类药物的总用量。次要结局指标包括疼痛评分、每6小时间隔的阿片类药物累积用量、恶心和呕吐、术后活动能力、首次使用阿片类药物的时间、体位性低血压或不耐受、术后恢复质量-15评分、手术并发症、住院时间及不良事件。
与盐水组相比，罗哌卡因组术后24小时内阿片类药物的总用量未显著减少（平均129 mg（标准差88.4）vs平均127.2 mg（标准差89.9），p = 0.93）。此外，次要结局指标在组间均未显示出任何具有统计学意义的差异。
作为腹腔镜半结肠切除术多模式镇痛方案的一部分，术前双侧腰方肌前侧神经阻滞并未显著减少术后24小时的阿片类药物用量。NCT03570541。
