Zhu Youzhuang, Li Zhichao, Qin Shangyuan, Xu Hao, He Jianshuai, Sheng Fang, Zhao Qin, Kang Yihan, Gao Xin, Li Si, Chai Jun, Chen Lina, Wang Weiwei
Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Front Oncol. 2022 Oct 6;12:969452. doi: 10.3389/fonc.2022.969452. eCollection 2022.
We hypothesized that posterior quadratus lumborum block would reduce postoperative opioid consumption and improve the quality of recovery in patients undergoing sutureless laparoscopic partial nephrectomy.
The study included 60 patients, ages 18-65 with American Society of Anesthesiologists scores of I-II scheduled for elective sutureless laparoscopic partial nephrectomy. Before general anesthesia, 60 participating patients were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.375% ropivacaine ( = 30) or normal saline ( = 30). The primary outcomes included cumulative opioid consumption within 12 h postoperatively and quality of postoperative recovery at 48 h. Secondary outcomes included the Numerical Rating Scale (NRS), opioid consumption by period, first time to press the analgesic pump, number of patients needing rescue analgesia, blood glucose and cortisol concentrations, early postoperative recovery indicators, and adverse events.
There were 48 patients included in the final analysis. The intervention group had lower cumulative consumption of sufentanil within 12 h postoperatively and higher quality of postoperative recovery scores at 48 h postoperatively compared with the control group ( < 0.001). The NRS at resting and movement of the intervention group was lower at 0 h, 6 h, and 12 h after surgery than in the control group ( < 0.05). At prespecified intervals (0 to 2 h, 2 to 6 h, 6 to 12 h, 12 to 24 h, and 24 to 48 h) after surgery, the intervention group had lower consumption of sufentanil compared with the control group ( < 0.05). The intervention group took longer to press the analgesic pump for the first time within 48 h after surgery compared with the control group ( < 0.001). The postoperative blood glucose and cortisol concentrations in the intervention group were lower than in the control group ( < 0.05). The times to first excretion, ambulation, and discharge were shorter in the intervention group compared with the control group ( < 0.05). There was no significant difference in adverse events between the two groups.
Our trial demonstrated that patients who received posterior quadratus lumborum block had significantly lower opioid consumption within 12 h postoperatively and had a better quality of recovery at 48 h postoperatively. Therefore, we recommend posterior quadratus lumborum block as an option for postoperative analgesia in patients undergoing sutureless laparoscopic partial nephrectomy.
http://www.chictr.org.cn, identifier ChiCTR2100053439.
我们推测，腰方肌后路阻滞可减少接受无缝合腹腔镜部分肾切除术患者的术后阿片类药物用量，并改善恢复质量。
本研究纳入60例年龄在18 - 65岁、美国麻醉医师协会评分I - II级、计划行择期无缝合腹腔镜部分肾切除术的患者。在全身麻醉前，60例参与研究的患者被随机分配，在腰方肌后方接受30 ml的0.375%罗哌卡因注射（n = 30）或生理盐水注射（n = 30）。主要结局包括术后12小时内的累积阿片类药物用量以及术后48小时的恢复质量。次要结局包括数字评分量表（NRS）、按时间段的阿片类药物用量、首次按压镇痛泵的时间、需要补救镇痛的患者数量、血糖和皮质醇浓度、术后早期恢复指标以及不良事件。
最终分析纳入48例患者。与对照组相比，干预组术后12小时内舒芬太尼的累积用量更低，术后48小时的术后恢复质量评分更高（P < 0.001）。干预组在术后0小时、6小时和12小时静息及活动时的NRS低于对照组（P < 0.05）。在术后预定时间段（0至2小时、2至6小时、6至12小时、12至24小时以及24至48小时），干预组的舒芬太尼用量低于对照组（P < 0.05）。与对照组相比，干预组在术后48小时内首次按压镇痛泵的时间更长（P < 0.001）。干预组术后血糖和皮质醇浓度低于对照组（P < 0.05）。与对照组相比，干预组首次排尿、下床活动和出院的时间更短（P < 0.05）。两组不良事件无显著差异。
我们的试验表明，接受腰方肌后路阻滞的患者术后12小时内阿片类药物用量显著更低，术后48小时恢复质量更好。因此，我们推荐腰方肌后路阻滞作为无缝合腹腔镜部分肾切除术患者术后镇痛的一种选择。
