Brandão Virna Guedes Alves, Silva Gustavo Nascimento, Perez Marcelo Vaz, Lewandrowski Kai-Uwe, Fiorelli Rossano Kepler Alvim
Department of Anesthesiology, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, RJ, Brazil.
Department of Surgery and Anesthesia, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, SP, Brazil.
J Pers Med. 2023 Mar 27;13(4):586. doi: 10.3390/jpm13040586.
There are many surgical and anesthetic factors that affect pain and the endocrine-metabolic response to trauma. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years.
To evaluate if the anterior quadratus lumborum block contributes to improved surgical recovery, using as parameters analgesia, pulmonary function and neuroendocrine response to trauma.
We carried out a prospective, randomized, controlled, and blinded study, in which 51 patients scheduled for laparoscopic cholecystectomy. Patients were randomly selected and assigned to 2 groups. The control group received balanced general anesthesia and venous analgesia, and the intervention group was treated under general, venous analgesia and anterior quadratus lumborum block. The parameters evaluated were: demographic data, postoperative pain, respiratory muscle pressure and inflammatory response to surgical stress with the plasma dosage of IL-6 (Interleukin 6), CRP (C-Reactive protein) and cortisol.
Anterior quadratus lumborum block induced the slowing of IL-6 cytokine production and a decrease in cortisol release. This effect was accompanied by the significant reduction of postoperative pain scores.
Anterior quadratus lumborum block is an important strategy for analgesia in abdominal laparoscopic surgery and contributes to reducing the inflammatory response to surgical trauma with an early return of preoperative baseline physiological functions.
有许多手术和麻醉因素会影响疼痛以及机体对创伤的内分泌代谢反应。在过去几年中，麻醉药物和神经阻滞改变机体对手术创伤反应的能力已得到广泛研究。
以前列腰方肌阻滞是否有助于改善手术恢复为评估内容，将镇痛、肺功能和机体对创伤的神经内分泌反应作为参数。
我们开展了一项前瞻性、随机、对照、双盲研究，其中51例患者计划行腹腔镜胆囊切除术。患者被随机选取并分为2组。对照组接受平衡全身麻醉和静脉镇痛，干预组在全身麻醉、静脉镇痛及前列腰方肌阻滞下接受治疗。评估的参数包括：人口统计学数据、术后疼痛、呼吸肌压力以及通过血浆中白细胞介素6（IL - 6）、C反应蛋白（CRP）和皮质醇的剂量来评估手术应激的炎症反应。
前列腰方肌阻滞导致IL - 6细胞因子产生减缓以及皮质醇释放减少。这一效应伴随着术后疼痛评分的显著降低。
前列腰方肌阻滞是腹部腹腔镜手术镇痛的一项重要策略，有助于减轻手术创伤的炎症反应，并使术前基线生理功能早日恢复。
