Yin Xinrui, Tian Xue, Wang Bingyi, Yang Yi, Tang Xiaodong, Feng Yi, Jiang Luyang
Department of Anesthesiology, People's Hospital, Peking University, Beijing, 100044, China.
Department of Orthopedic Oncology, People's Hospital, Peking University, Beijing, China.
J Orthop Surg Res. 2025 May 29;20(1):541. doi: 10.1186/s13018-025-05968-w.
A wide range of pain management techniques have been investigated following pelvic tumor resection and reconstruction surgery; however, the optimal components remain a subject of debate. In this prospective randomized controlled trial, we assessed the postoperative analgesic efficacy of integrating lateral quadratus lumborum block (Lateral-QLB) and anterior quadratus lumborum block (Anterior-QLB) with multimodal analgesia (MMA) regimen, compared to MMA regimen alone, in patients undergoing pelvic tumor resection and reconstruction.
A total of 56 patients were randomly allocated to either the QLB group (n = 28) or the No Block group (n = 28). The QLB group received an ultrasound-guided Combined quadratus lumborum block (a combination of Lateral-QLB and Anterior-QLB), with 20 mL of 0.375% ropivacaine administered on each approach. The No Block group received standardized multimodal analgesia. Both groups followed an identical postoperative patient-controlled intravenous analgesia protocol. Outcomes included opioid consumption (intravenous morphine milligram equivalents, IV MME) at multiple time points within 48 h postoperatively, time to first opioid request, resting/activity-related pain scores, postoperative neurological assessments (lower extremity motor and sensory function), recovery quality quantified using QoR-15 (Quality of Recovery-15) scores on postoperative days (POD) 1, 2, and 7, and chronic pain prevalence during a 3-month follow-up.
The QLB group exhibited significant reductions in cumulative IV MME at 24 h (18.56 ± 6.63 vs. 24.29 ± 5.69 mg, p = 0.001) and 48 h (27.87 ± 9.95 vs. 41.29 ± 9.67 mg, p < 0.001), along with an extended time to the first opioid request (median 5.0 vs. 4.0 h, p = 0.005). Resting/activity pain scores were consistently lower (p = 0.008/p = 0.003), accompanied by transient sensory changes in the abdomen/thigh without motor impairment. QoR-15 scores significantly favored the QLB group (p < 0.05), with lower chronic pain rates at 3 months post-surgery compared to the No Block group (7.1% vs. 32.1%, p = 0.021).
The ultrasound-guided QLB demonstrated superior analgesic efficacy and reduced morphine consumption compared to patients without the block. Our findings provide evidence supporting the hypothesis that QLB is an effective component of multimodal analgesia for individuals undergoing pelvic tumor resection and reconstructive surgery.
盆腔肿瘤切除与重建手术后，人们对多种疼痛管理技术进行了研究；然而，最佳的组合方式仍存在争议。在这项前瞻性随机对照试验中，我们评估了在盆腔肿瘤切除与重建手术患者中，将腰方肌外侧阻滞（Lateral-QLB）和腰方肌前侧阻滞（Anterior-QLB）与多模式镇痛（MMA）方案相结合的术后镇痛效果，并与单纯的MMA方案进行比较。
总共56例患者被随机分配到QLB组（n = 28）或无阻滞组（n = 28）。QLB组接受超声引导下的联合腰方肌阻滞（腰方肌外侧阻滞和腰方肌前侧阻滞的联合），每种方法注射20 mL 0.375%的罗哌卡因。无阻滞组接受标准化的多模式镇痛。两组均遵循相同的术后患者自控静脉镇痛方案。观察指标包括术后48小时内多个时间点的阿片类药物消耗量（静脉注射吗啡毫克当量，IV MME）、首次请求使用阿片类药物的时间、静息/活动相关疼痛评分、术后神经学评估（下肢运动和感觉功能）、术后第1、2和7天使用QoR-15（恢复质量-15）评分量化的恢复质量，以及3个月随访期间的慢性疼痛发生率。
QLB组在24小时（18.56±6.63 vs. 24.29±5.69 mg，p = 0.001）和48小时（27.87±9.95 vs. 41.29±9.67 mg，p < 0.001）的累积IV MME显著降低，首次请求使用阿片类药物的时间延长（中位数5.0 vs. 4.0小时，p = 0.005）。静息/活动疼痛评分持续较低（p = 0.008/p = 0.003），伴有腹部/大腿短暂的感觉变化但无运动障碍。QoR-15评分显著有利于QLB组（p < 0.05），与无阻滞组相比，术后3个月的慢性疼痛发生率较低（7.1% vs. 32.1%，p = 0.021）。
与未接受阻滞的患者相比，超声引导下的QLB显示出更好的镇痛效果和减少了吗啡消耗量。我们的研究结果为支持QLB是盆腔肿瘤切除与重建手术患者多模式镇痛的有效组成部分这一假设提供了证据。
