结直肠腹腔镜手术中的区域麻醉:腰方肌阻滞与腹横肌平面阻滞的回顾性比较

Regional anesthesia in colorectal laparoscopy: a retrospective comparison of quadratus lumborum and TAP blocks.

作者信息

Oliță Mihaela Roxana, Eftimie Mihai Adrian, Andreșanu Andrei, Dobra Mihai Adrian, Mirea Elena Liliana, Tomescu Dana Rodica

机构信息

Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania.

Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

出版信息

J Med Life. 2025 Apr;18(4):285-291. doi: 10.25122/jml-2025-0067.

Abstract

Effective postoperative pain control is pivotal in enhancing recovery following laparoscopic colorectal surgery. Regional anesthesia techniques such as the transversus abdominis plane (TAP) block and the quadratus lumborum (QL) block have gained prominence as components of multimodal analgesia. However, their comparative efficacy remains underexplored. This retrospective observational cohort study analyzed data from 289 patients undergoing laparoscopic colon surgery. Patients were stratified into three groups: TAP block (Group A, = 54), QL block (Group B, = 62), and no regional block (Group C, = 173). Primary endpoints included time to first analgesic administration and total analgesic consumption (opioids and non-opioids). Statistical analyses were conducted using R (v4.4.2) and Jamovi (v2.3), with significance set at < 0.05. Group B (QL block) demonstrated significantly reduced opioid consumption (mean 13.16 ± 2.69 mg) compared to both Group A (16.80 ± 5.51 mg) and Group C (18.03 ± 4.29 mg), < 0.001. Time to first analgesic request was longer in Group B (16.06 ± 2.53 h), indicating more durable analgesia. Non-opioid usage (paracetamol, tramadol, nefopam) was similarly lower in Group B across all comparisons ( < 0.001). Group B also exhibited a significantly shorter hospital stay (4.87 ± 1.14 days) relative to Groups A and C. The QL block was associated with superior postoperative analgesia, reduced opioid and adjunct analgesic requirements, prolonged pain-free intervals, and accelerated postoperative recovery in laparoscopic colorectal surgery. These findings underscore QL block as a potent element of opioid-sparing, multimodal analgesic strategies and support its broader adoption in enhanced recovery protocols.

摘要

有效的术后疼痛控制对于促进腹腔镜结直肠手术后的恢复至关重要。腹横肌平面(TAP)阻滞和腰方肌(QL)阻滞等区域麻醉技术作为多模式镇痛的组成部分已受到广泛关注。然而,它们的相对疗效仍未得到充分研究。这项回顾性观察性队列研究分析了289例接受腹腔镜结肠手术患者的数据。患者被分为三组:TAP阻滞组(A组,n = 54)、QL阻滞组(B组,n = 62)和未进行区域阻滞组(C组,n = 173)。主要终点包括首次使用镇痛药的时间和镇痛药总消耗量(阿片类药物和非阿片类药物)。使用R(v4.4.2)和Jamovi(v2.3)进行统计分析,显著性设定为P < 0.05。与A组(16.80±5.51 mg)和C组(18.03±4.29 mg)相比,B组(QL阻滞组)的阿片类药物消耗量显著降低(平均13.16±2.69 mg),P < 0.001。B组首次要求使用镇痛药的时间更长(16.06±2.53小时),表明镇痛效果更持久。在所有比较中,B组的非阿片类药物使用量(对乙酰氨基酚、曲马多、奈福泮)同样较低(P < 0.001)。与A组和C组相比,B组的住院时间也显著缩短(4.87±1.14天)。在腹腔镜结直肠手术中,QL阻滞与更好的术后镇痛、减少阿片类药物和辅助镇痛药需求、延长无痛间隔时间以及加速术后恢复相关。这些发现强调了QL阻滞作为阿片类药物节约型多模式镇痛策略的有效组成部分,并支持其在加速康复方案中更广泛的应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ca0/12094314/d21d1e6d8c8b/JMedLife-18-285-g001.jpg

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