Department of Anesthesiology, Peking University First Hospital, Beijing, China.
Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland, OH, USA.
J Clin Anesth. 2024 Sep;96:111466. doi: 10.1016/j.jclinane.2024.111466. Epub 2024 Apr 26.
We compared the analgesic effects of erector spinae plane block versus quadratus lumborum block following laparoscopic nephrectomy.
A randomized controlled trial.
A tertiary hospital in Beijing, China.
Patients scheduled for elective laparoscopic nephrectomy.
A total of 110 patients were enrolled and randomized to receive either erector spinae plane block (n = 55) or quadratus lumborum block (n = 55) under ultrasound guidance. Patient-controlled sufentanil analgesia was provided after surgery.
Our primary outcome was cumulative opioid consumption within 24 h after surgery. Secondary outcomes included postoperative pain intensity, subjective sleep quality, and quality of recovery.
All 110 patients (mean 53 years, 57.3% female) were included in the intention-to-treat analysis. Cumulative sufentanil equivalent within 24 h was lower in patients given erector spinae plane block (median 13 μg, interquartile range 4 to 33) than in those given quadratus lumborum block (median 25 μg, interquartile range 13 to 39; median difference - 8 μg, 95% CI -15 to 0, P = 0.041). Pain intensity (0-10 range where 0 = no pain and 10 = the worst pain) at 2, 6, 12, and 24 h after surgery was lower with erector spinae plane block (at rest: median differences -1 point, all P ≤ 0.009; with movement: median differences -2 to -1 points, all P < 0.001). Subjective sleep quality on the night of surgery (the Richards-Campbell Sleep Questionnaire: 0-100 range, higher score better; median difference 12, 95% CI 2 to 23, P = 0.018) and quality of recovery at 24 h (the Quality of Recovery-15: 0-150 range, higher score better; median difference 8, 95% CI 2 to 15, P = 0.012) were better with erector spinae plane block. No procedure-related adverse events occurred.
Compared with quadratus lumborum block, erector spinae plane block provided better analgesia as manifested by lower opioid consumption and pain intensity for up to 24 h after laparoscopic nephrectomy.
我们比较了腹腔镜肾切除术后竖脊肌平面阻滞与腰方肌阻滞的镇痛效果。
随机对照试验。
中国北京的一家三级医院。
拟行择期腹腔镜肾切除术的患者。
共纳入 110 例患者，随机分为接受竖脊肌平面阻滞（n=55）或腰方肌阻滞（n=55）的患者。术后给予患者自控舒芬太尼镇痛。
我们的主要结局是术后 24 小时内累积阿片类药物消耗量。次要结局包括术后疼痛强度、主观睡眠质量和恢复质量。
所有 110 例患者（平均年龄 53 岁，57.3%为女性）均进行意向治疗分析。接受竖脊肌平面阻滞的患者 24 小时内舒芬太尼等效累积量较低（中位数 13μg，四分位距 4 至 33μg；中位数差值-8μg，95%CI-15 至 0，P=0.041）。术后 2、6、12 和 24 小时静息时（中位数差异 1 分，所有 P≤0.009；活动时（中位数差异 2 至 1 分，所有 P<0.001）疼痛强度（0-10 分，0 为无痛，10 为最痛）较低。术后当晚主观睡眠质量（Richard-Campbell 睡眠问卷：0-100 分，分数越高越好；中位数差异 12 分，95%CI 2 至 23 分，P=0.018）和 24 小时时恢复质量（Quality of Recovery-15：0-150 分，分数越高越好；中位数差异 8 分，95%CI 2 至 15 分，P=0.012）较好。无与操作相关的不良事件发生。
与腰方肌阻滞相比，竖脊肌平面阻滞在腹腔镜肾切除术后 24 小时内提供了更好的镇痛效果，表现为阿片类药物消耗和疼痛强度降低。
