Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China.
Department of Anesthesiology, Hainan General Hospital, Haikou, 570311, Hainan, China.
Sci Rep. 2024 Feb 26;14(1):4652. doi: 10.1038/s41598-024-55370-5.
In the past, quadratus lumborum block (QLB) was mostly used for postoperative analgesia in patients, and few anesthesiologists applied it during surgery with opioid-free anesthesia (OFA). Consequently, it is still unclear whether QLB in the supine position can provide perfect analgesia and inhibit anesthetic stress during surgery under the OFA strategy. To observe the clinical efficacy of ultrasound-guided quadratus lumborum block (US-QLB) in the supine position with OFA for lower abdominal and pelvic surgery. A total of 122 patients who underwent lower abdominal or pelvic surgery in People's Hospital of Wanning between March 2021 and July 2022 were selected and divided into a quadratus lumborum block group (Q) (n = 62) and control group (C) (n = 60) according to the random number table method. Both groups underwent general anesthesia combined with QLB in the supine position. After sedation, unilateral or bilateral QLB was performed via the ultrasound guided anterior approach based on images resembling a "human eye" and "baby in a cradle" under local anesthesia according to the needs of the operative field. In group Q, 20 ml of 0.50% lidocaine and 0.20% ropivacaine diluted in normal saline (NS) were injected into each side. In group C, 20 ml of NS was injected into each side. The values of BP, HR, SO, SE, RE, SPI, NRS, Steward score, dosage of propofol, dexmedetomidine, and rocuronium, the number of patients who needed remifentanil, propofol, or diltiazem, puncture point, block plane, duration of anesthesia, catheter extraction, and wakefulness during the operation were monitored. There were no significant differences in the general data, number of cases requiring additional remifentanil, propofol, or diltiazem treatment, as well as puncture point and puncture plane between the two groups (P > 0.05). HR, SBP, and DBP values were higher in group Q than in group C at T1; HR, SPI, and SE, while RE values were lower in group Q than in group C at T3, SE, and RE; the Steward score was higher in group Q than in group C at T4 and T5, and the difference was statistically significant (P < 0.05). The extubation and awake times were lower in group Q than in group C, and the difference was statistically significant (P < 0.05). The SE, RE, and SPI values were lower at T1, T2, T3, and T4 than at T0. The Steward scores at T4 and T5 were higher in group Q than in group C, and were lower than at T0, with a statistically significant difference (P < 0.05). There were significant differences in the effectiveness of postoperative analgesia between the two groups at t1, t3 and t4 (P < 0.05). US-QLB in the supine position with OFA is effective in patients undergoing lower abdominal or pelvic surgery with stable intraoperative vital signs, complete recovery and better postoperative analgesia.
在过去，腹横肌平面阻滞（QLB）主要用于术后患者的镇痛，很少有麻醉师在无阿片类药物麻醉（OFA）下的手术中使用。因此，QLB 在仰卧位是否可以在 OFA 策略下提供完美的镇痛并抑制麻醉应激仍不清楚。为观察超声引导下腹横肌平面阻滞（US-QLB）在仰卧位下行下腹部和盆腔手术的临床疗效。选择 2021 年 3 月至 2022 年 7 月在万宁市人民医院行下腹部或盆腔手术的 122 例患者，按随机数字表法分为腹横肌阻滞组（Q）（n=62）和对照组（C）（n=60）。两组均行全身麻醉联合仰卧位 QLB。镇静后，根据手术野需要，在局部麻醉下，采用超声引导前路，在图像上呈现“人眼”和“婴儿摇篮”的类似形态，行单侧或双侧 QLB。在 Q 组，每侧注射 20ml 0.50%利多卡因和 0.20%罗哌卡因稀释在生理盐水（NS）中。在 C 组，每侧注射 20ml NS。监测两组患者的血压（BP）、心率（HR）、血氧饱和度（SO）、镇静评分（SE）、呼吸频率（RE）、脑状态指数（SPI）、数字评分量表（NRS）、苏醒评分、丙泊酚、右美托咪定和罗库溴铵的用量、需要瑞芬太尼的患者人数、丙泊酚或地尔硫卓的用量、穿刺点、阻滞平面、麻醉持续时间、导管拔出和清醒时间。两组患者的一般资料、需要额外瑞芬太尼、丙泊酚或地尔硫卓治疗的例数、穿刺点和穿刺平面比较差异均无统计学意义（P＞0.05）。与 C 组比较，Q 组 T1 时 HR、收缩压（SBP）和舒张压（DBP）较高；T3 时 HR、SPI 和 SE 较低，RE 较高；T4、T5 时苏醒评分较高，差异均有统计学意义（P＜0.05）。与 C 组比较，Q 组患者的拔管和清醒时间较低，差异有统计学意义（P＜0.05）。与 T0 时比较，T1、T2、T3 和 T4 时 SE、RE 和 SPI 较低。T4、T5 时 Q 组的苏醒评分高于 C 组，且低于 T0，差异均有统计学意义（P＜0.05）。两组患者术后 t1、t3、t4 时的镇痛效果比较差异均有统计学意义（P＜0.05）。OFA 下仰卧位 US-QLB 用于下腹部和盆腔手术，术中生命体征稳定，恢复完全，术后镇痛效果更好。
