Kim Dongju, Bang Seunguk, Chung Jihyun, Lee Youngin, Shin Hyun-Jung, Park Yoonji
Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea.
Medicina (Kaunas). 2025 Jun 13;61(6):1084. doi: 10.3390/medicina61061084.
: Regional anesthesia is a key component of multimodal analgesia following minimally invasive gynecologic surgery. However, single-port laparoscopic adnexal surgery differs anatomically and physiologically from multiport or open approaches, particularly in terms of incision site, tissue handling, and pain characteristics. Despite its increasing use, evidence supporting procedure-specific regional analgesic protocols for this approach remains limited. This study aimed to compare the analgesic efficacy of quadratus lumborum block (QLB) and rectus sheath block (RSB) in this surgical context. : In this randomized controlled trial, 68 patients undergoing single-port laparoscopic adnexal surgery were randomly assigned to receive either QLB or RSB at the end of surgery. Four patients were excluded due to missing patient-controlled analgesia (PCA) data, resulting in 64 patients analyzed (QLB group: = 32; RSB group: = 32). The primary outcome was cumulative opioid consumption over the first 24 postoperative hours. Secondary outcomes included interval-based opioid consumption, time to first PCA bolus, postoperative pain scores, and incidence of postoperative nausea and vomiting (PONV). : The RSB group demonstrated significantly lower cumulative opioid consumption at 24 h postoperatively (132.9 [61.3, 338.4] µg vs. 453.0 [253.1, 811.0] µg, < 0.001). This trend persisted across most postoperative time points up to 48 h. Interval-based opioid consumption was also lower in the RSB group during 0-24 h and 32-48 h intervals (each comparison < 0.05). The time to first PCA bolus was significantly longer in the RSB group (56.5 [41.0, 340.3] minutes vs. 40.5 [33.3, 68.8] minutes; = 0.014), and Kaplan-Meier analysis confirmed a delayed first bolus request in the RSB group (log-rank = 0.007). Pain scores and postoperative nausea and vomiting incidence were comparable between groups. : Compared with QLB, RSB provided similar pain relief with significantly lower opioid consumption following single-port laparoscopic adnexal surgery. These findings highlight the potential advantages of RSB in enhancing analgesic efficiency and support the development of procedure-specific regional analgesia protocols tailored to this surgical approach.
区域麻醉是微创妇科手术后多模式镇痛的关键组成部分。然而，单孔腹腔镜附件手术在解剖学和生理学上与多孔或开放手术方法不同，特别是在切口部位、组织处理和疼痛特征方面。尽管其使用越来越广泛，但支持该手术方法特定区域镇痛方案的证据仍然有限。本研究旨在比较在此手术背景下腰方肌阻滞（QLB）和腹直肌鞘阻滞（RSB）的镇痛效果。
在这项随机对照试验中，68例行单孔腹腔镜附件手术的患者在手术结束时被随机分配接受QLB或RSB。4例患者因缺少患者自控镇痛（PCA）数据而被排除，最终纳入分析64例患者（QLB组：n = 32；RSB组：n = 32）。主要结局是术后24小时内的累积阿片类药物消耗量。次要结局包括基于时间段的阿片类药物消耗量、首次PCA推注时间、术后疼痛评分以及术后恶心呕吐（PONV）的发生率。
RSB组术后24小时的累积阿片类药物消耗量显著更低（132.9 [61.3, 338.4] μg vs. 453.0 [253.1, 811.0] μg，P < 0.001）。这一趋势在术后长达48小时的大多数时间点持续存在。在0 - 24小时和32 - 48小时时间段内，RSB组基于时间段的阿片类药物消耗量也更低（每项比较P < 0.05）。RSB组首次PCA推注时间显著更长（56.5 [41.0, 340.3]分钟 vs. 40.5 [33.3, 68.8]分钟；P = 0.014），Kaplan - Meier分析证实RSB组首次推注请求延迟（对数秩检验P = 0.007）。两组间疼痛评分和术后恶心呕吐发生率相当。
与QLB相比，RSB在单孔腹腔镜附件手术后提供了相似的疼痛缓解，且阿片类药物消耗量显著更低。这些发现突出了RSB在提高镇痛效率方面的潜在优势，并支持为这种手术方法量身定制特定手术区域镇痛方案的开发。
