Roy Avishek, Bhoi Debesh, Chhabra Anjolie, Mohan Virender K, Darlong Vanlalnghaka, Prasad Ganga
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Indian J Anaesth. 2023 Feb;67(2):207-215. doi: 10.4103/ija.ija_304_22. Epub 2023 Feb 16.
BACKGROUND AND AIMS: Laparoscopic trans abdominal preperitoneal (TAPP) repair of hernia is one of the most commonly performed surgeries and may cause significant postoperative pain. Among different truncal block techniques, quadratus lumborum (QL) and transversus abdominis plane blocks (TAP) are used during this abdominal surgery. We aimed to investigate whether, bilateral QL block by trans-muscular approach provided better analgesia as compared to posterior TAP block in these patients. METHODS: Forty adult patients with American Society of Anesthesiologists physical status I and II, undergoing inguinal hernia repair were randomized to receive either QL or TAP block, with 20 mL of 0.25% ropivacaine bilaterally. The primary objective of the study was to compare the total fentanyl consumption (in μg) within 24 hours postoperatively. The secondary objectives studied were dermatomal spread, quality of recovery at discharge and at 3 months postoperatively. RESULTS: There was a significant reduction in total 24-hour fentanyl consumption (552 ± 229.56 vs 735.5 ± 264 μg, =0.01) in the QL group, with longer duration of analgesia [282.5 ± 89.9 min group TAP vs. 354.8 ± 107 min QL, (mean difference -72.34,95% confidence interval -135.516 to -9.024), =0.03], as compared to TAP group. At T8 and T9 dermatomes, greater proportion of patients in the QL group attained analgesia. Quality of Recovery at 24 hours and at 3 months of follow-up were comparable. CONCLUSION: QL block provided better perioperative analgesia than TAP block, in patients undergoing laparoscopic hernia repair. It also leads to greater dermatomal spread but without any decrease in the incidence of chronic pain at 3 months postoperatively.
背景与目的:腹腔镜经腹腹膜前(TAPP)疝修补术是最常开展的手术之一,术后可能会引起明显疼痛。在不同的躯干阻滞技术中,腰方肌(QL)阻滞和腹横肌平面阻滞(TAP)用于此类腹部手术。我们旨在研究在这些患者中,经肌层双侧QL阻滞与后路TAP阻滞相比是否能提供更好的镇痛效果。 方法:40例美国麻醉医师协会身体状况分级为I级和II级、接受腹股沟疝修补术的成年患者被随机分为接受QL阻滞或TAP阻滞两组,双侧均注射20 mL 0.25%的罗哌卡因。该研究的主要目的是比较术后24小时内芬太尼的总消耗量(以μg为单位)。次要研究目的包括皮节扩散、出院时及术后3个月的恢复质量。 结果:QL组术后24小时芬太尼总消耗量显著降低(552±229.56 vs 735.5±264 μg,P=0.01),与TAP组相比,镇痛持续时间更长[QL组为354.8±107分钟,TAP组为282.5±89.9分钟,(平均差值-72.34,95%置信区间-135.516至-9.024),P=0.03]。在T8和T9皮节,QL组有更大比例的患者获得了镇痛效果。术后24小时及随访3个月时的恢复质量相当。 结论:在接受腹腔镜疝修补术的患者中,QL阻滞比TAP阻滞提供了更好的围手术期镇痛效果。它还导致更大的皮节扩散,但术后3个月慢性疼痛的发生率没有任何降低。
Anesthesiology. 2019-2