Alves Brandão Virna Guedes, Silva Gustavo Nascimento, Alvim Fiorelli Rossano Kepler, Perez Marcelo Vaz
Gaffrée e Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro(UNIRIO), Brazil.
Surgery and Anesthesia Department, Federal University of São Paulo (UNIFESP), Brazil.
Surg Innov. 2023 Jun;30(3):283-296. doi: 10.1177/15533506231159161. Epub 2023 Feb 28.
Laparoscopy revolutionizing digital and robotic technology for surgical practice. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years.
evaluate if Anterior Quadratus Lumborum Block contributes to attenuate surgical repercussions, having as primary parameters analgesia and secondary the pulmonary function and neuroendocrine response to trauma.
prospective, controlled, Double-blind study, in which 51 patients scheduled for eletive laparoscopic cholecystectomy were randomly selected and distributed into 2 groups. Control group received general anesthesia, and the intervention group was submitted to general anesthesia plus Anterior Quadratus Lumborum Block. The parameters evaluated were: postoperative pain, respiratory muscle pressure, and inflammatory response to surgical stress with the plasma dosage of Interleukin 6, C-Reactive protein and cortisol. The following situations were excluded: refusal to participate in the study; body mass index greater than or equal to 40, peripheral neuropathies, coagulopathies or hypersensitivity to drugs used; infection at the puncture site; fever, purities; dementia or other states that would prevent the adequate understanding of the use of the numeric-verbal scale of pain; immunological diseases, diabetes, malignant neoplasia, use of opioids or anti-inflammatory drugs in the preoperative period; antidepressants and anticonvulsants, conversion open surgery, re-exploration and hospital stay.
Slowed Interleukin 6 cytokine production and decrease in cortisol release, accompanied by significant attenuation of surgical repercussion on lung function and significant reduction in postoperative pain scores and consumption of pain medication.
An important strategy for analgesia in abdominal laparoscopic surgery.
腹腔镜检查正在彻底改变外科手术的数字和机器人技术。在过去几年中，麻醉剂和神经阻滞对手术创伤反应的影响已得到广泛研究。
评估腰方肌前路阻滞是否有助于减轻手术影响，以镇痛作为主要参数，肺功能和对创伤的神经内分泌反应作为次要参数。
前瞻性、对照、双盲研究，将51例计划行择期腹腔镜胆囊切除术的患者随机选取并分为2组。对照组接受全身麻醉，干预组接受全身麻醉加腰方肌前路阻滞。评估的参数包括：术后疼痛、呼吸肌压力以及通过血浆中白细胞介素6、C反应蛋白和皮质醇的剂量来评估对手术应激的炎症反应。排除以下情况：拒绝参与研究；体重指数大于或等于40、周围神经病变、凝血功能障碍或对所用药物过敏；穿刺部位感染；发热、脓毒症；痴呆或其他会妨碍充分理解疼痛数字-语言量表使用的状态；免疫性疾病、糖尿病、恶性肿瘤、术前使用阿片类药物或抗炎药物；抗抑郁药和抗惊厥药、转为开放手术、再次探查和住院时间。
白细胞介素6细胞因子产生减缓，皮质醇释放减少，同时手术对肺功能的影响明显减轻，术后疼痛评分显著降低，止痛药物消耗量减少。
腹部腹腔镜手术镇痛的一项重要策略。
