Elsayed Elashry Hesham, Abdelbadie Mohamed, Ali Elshabacy Abeer, Ali Elmiseery Omnia
Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Anesthesiology, Surgical ICU and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
Anesth Pain Med. 2024 Jan 17;14(1):e140464. doi: 10.5812/aapm-140464. eCollection 2024 Feb.
Appropriate pain management promotes immediate mobilization and allows the parturient to adequately care for her neonate after cesarean section (CS).
This trial objective was to compare the type III and type II quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) regarding postoperative analgesic effect in CS.
This randomized, controlled, single-blind trial involved 60 women presenting for CS under spinal anesthesia. The patients were assigned randomly to either the QLB type III, QLB type II, or lateral TAPB group. All blocks were performed using 20 mL of bupivacaine 0.25% bilaterally at the end of the operation with ultrasound guidance. Pain was assessed using the numerical rating scale (NRS) score at the post-anesthesia care unit (PACU) at 2, 4, 6, 8, 12, 18, and 24 hours. The level of patient satisfaction was graded on a 5-point Likert scale.
Numerical rating scale measurements at 6, 8, and 12 hours and total consumed meperidine in the 1st 24 hours after the operation were reduced significantly in QLB III than in QLB II and TAPB groups (P < 0.05) with an insignificant difference between the QLB II and TAPB groups (P > 0.05). The onset of the first request for analgesia was delayed significantly in QLB III, compared to QLB II and TAPB groups (P < 0.05), without a significant difference between the QLB II and TAPB groups (P > 0.05). Patient satisfaction and adverse events (e.g., postoperative nausea and vomiting, bradycardia, and hypotension) exhibited insignificant differences among the three groups (P > 0.05).
The QLB type III ensured better analgesia as evidenced by significantly lower pain measurements and amount of meperidine in the first 24 hours after the operation with delayed time of the first rescue analgesia in comparison to QLB II and TAPB; however, QLB II and TAPB were similar.
恰当的疼痛管理有助于产妇术后立即活动，并使其能够在剖宫产术后充分照顾新生儿。
本试验旨在比较III型和II型腰方肌阻滞（QLB）与腹横肌平面阻滞（TAPB）对剖宫产术后的镇痛效果。
本随机、对照、单盲试验纳入了60例接受腰麻下行剖宫产手术的女性患者。患者被随机分配至III型QLB组、II型QLB组或外侧TAPB组。所有阻滞均在手术结束时于超声引导下双侧使用20 mL 0.25%布比卡因进行。在麻醉后恢复室（PACU）于术后2、4、6、8、12、18和24小时使用数字评分量表（NRS）评估疼痛。患者满意度采用5级李克特量表进行评分。
术后6、8和12小时的数字评分量表测量值以及术后第1个24小时内哌替啶的总消耗量，III型QLB组显著低于II型QLB组和TAPB组（P<0.05），而II型QLB组和TAPB组之间差异无统计学意义（P>0.05）。与II型QLB组和TAPB组相比，III型QLB组首次要求镇痛的时间显著延迟（P<0.05），II型QLB组和TAPB组之间差异无统计学意义（P>0.05）。三组患者的满意度和不良事件（如术后恶心呕吐、心动过缓和低血压）差异无统计学意义（P>0.05）。
与II型QLB和TAPB相比，III型QLB在术后第1个24小时疼痛测量值和哌替啶用量显著降低且首次补救镇痛时间延迟方面，确保了更好的镇痛效果；然而，II型QLB和TAPB效果相似。
