Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium.
Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Anaesthesia. 2024 Jan;79(1):54-62. doi: 10.1111/anae.16177. Epub 2023 Nov 16.
We investigated the efficacy and safety of a bilateral anterior quadratus lumborum block in patients undergoing minimally invasive colorectal surgery. This was a two-centre, double-blind, prospective, randomised, placebo-controlled trial including 150 patients undergoing laparoscopic colorectal surgery (left- or right hemicolectomy, sigmoidectomy) who were enrolled in the institutional abdominal enhanced recovery programme. Before induction of anaesthesia, patients received a bilateral anterior quadratus lumborum block in the left and right lateral decubitus position under ultrasound guidance and were allocated randomly to receive 30 ml of ropivacaine 0.375% (n = 75) or placebo (saline 0.9%) (n = 75) bilaterally. Postoperatively, all patients received multimodal intravenous analgesia including paracetamol, ketorolac and patient-controlled analgesia with morphine. The primary outcome was morphine consumption during the first 24 h after tracheal extubation. Secondary outcomes included severity of pain; presence and extent of sensory block; incidence of postoperative nausea and vomiting; and hospital duration of stay. We also investigated the need for, and dose of, rescue analgesia. Safety outcomes included the incidence of adverse events. Mean (SD) 24-hour morphine consumption was no different between patients allocated to ropivacaine and placebo (28.6 (22.3) mg vs. 28.4 (22.5) mg, p = 0.966, respectively). While a sensory block could be detected in significantly more patients allocated to the ropivacaine group, no differences were detected in pain scores or other secondary or safety endpoints. Patient satisfaction scores were high in both groups. In laparoscopic colorectal surgery, adding a bilateral anterior quadratus lumborum block to a standard multimodal analgesia regimen did not reduce opioid consumption or improve pain scores.
我们研究了双侧竖脊肌肌间沟阻滞在微创结直肠手术患者中的疗效和安全性。这是一项两中心、双盲、前瞻性、随机、安慰剂对照试验，纳入了 150 名接受腹腔镜结直肠手术（左或右半结肠切除术、乙状结肠切除术）的患者，这些患者均参与了机构腹部强化康复计划。在麻醉诱导前，患者在超声引导下于侧卧位接受双侧竖脊肌肌间沟阻滞，并随机分为接受 30ml 0.375%罗哌卡因（n=75）或安慰剂（生理盐水 0.9%）（n=75）双侧注射。术后，所有患者均接受包括对乙酰氨基酚、酮咯酸和吗啡患者自控镇痛在内的多模式静脉镇痛。主要结局是气管拔管后 24 小时内吗啡的消耗量。次要结局包括疼痛严重程度、感觉阻滞的存在和程度、术后恶心和呕吐的发生率以及住院时间。我们还研究了需要和剂量的解救镇痛。安全性结局包括不良事件的发生率。接受罗哌卡因和安慰剂的患者 24 小时吗啡消耗量无差异（分别为 28.6（22.3）mg 和 28.4（22.5）mg，p=0.966）。虽然接受罗哌卡因的患者中可以检测到更多的感觉阻滞，但疼痛评分或其他次要和安全性终点没有差异。两组患者的满意度评分均较高。在腹腔镜结直肠手术中，将双侧竖脊肌肌间沟阻滞加入标准多模式镇痛方案并未减少阿片类药物的消耗或改善疼痛评分。
