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竖脊肌平面阻滞和腰方肌阻滞对腹腔镜肾手术术后阿片类药物用量的影响:一项随机对照临床试验

Effects of Erector Spinae Plane Block and Quadratus Lumborum Block on Postoperative Opioid Consumption in Laparoscopic Kidney Surgery: A Randomized Controlled Clinical Trial.

作者信息

Tomasz Skladzien, Pawel Maciejewski, Michal Cicio, Szpunar Wojciech, Jan Szpor, Tomasz Lonc, Anna Kwinta, Renata Bugielska, Olga Szkudlarek, Tomasz Drygalski, Michal Terlecki

机构信息

Department of Intensive Interdisciplinary Care, Jagiellonian University-Collegium Medicum, Cracow, Poland.

出版信息

Pain Res Manag. 2025 Aug 4;2025:8869716. doi: 10.1155/prm/8869716. eCollection 2025.

Abstract

The quadratus lumborum block (QLB) and erector spinae plane (ESP) block are relatively new regional analgesic techniques that provide analgesia to the abdominal wall and reduce postoperative opioid consumption. We compared the effectiveness of ultrasound-guided bilateral ESP block versus bilateral QLB in patients undergoing laparoscopic kidney surgery. Adult patients who underwent laparoscopic nephrectomy or nephron-sparing surgery (NSS) within the study period were included. Patients were randomly assigned to one of two groups: group I received an ultrasound-guided ESP block with 30 mL of 0.35% ropivacaine on each side and group II received an ultrasound-guided QLB 1 with 30 mL of 0.35% ropivacaine on each side. A total of 84 patients were included, with 45 patients in the ESP block group and 39 in the QLB group. The mean dosage of oxycodone in the ESP block group was 22.66 mg and in the QLB group was 22.66 mg. There was no difference in oxycodone consumption within the first 24 h after surgery between the groups (=0.77). The effect of ultrasound-guided bilateral QLB and ESP blocks in patients undergoing laparoscopic kidney surgery was found to be similar in terms of postoperative pain and opioid consumption. There were no significant differences between the blocks in opioid consumption or pain scores. Both techniques appear to be effective and safe components of multimodal analgesia strategy for laparoscopic nephrectomy. ClinicalTrials.gov identifier: NCT05446727.

摘要

腰方肌阻滞(QLB)和竖脊肌平面(ESP)阻滞是相对较新的区域镇痛技术,可提供腹壁镇痛并减少术后阿片类药物的使用。我们比较了超声引导下双侧ESP阻滞与双侧QLB在接受腹腔镜肾脏手术患者中的有效性。纳入了在研究期间接受腹腔镜肾切除术或保留肾单位手术(NSS)的成年患者。患者被随机分为两组之一:I组接受超声引导下双侧ESP阻滞,每侧注射30 mL 0.35%罗哌卡因,II组接受超声引导下双侧QLB1,每侧注射30 mL 0.35%罗哌卡因。总共纳入了84例患者,ESP阻滞组45例,QLB组39例。ESP阻滞组羟考酮的平均用量为22.66 mg,QLB组为22.66 mg。两组术后24小时内羟考酮的用量无差异(=0.77)。结果发现,超声引导下双侧QLB和ESP阻滞对接受腹腔镜肾脏手术患者的术后疼痛和阿片类药物消耗的影响相似。两组在阿片类药物消耗或疼痛评分方面无显著差异。这两种技术似乎都是腹腔镜肾切除术多模式镇痛策略中有效且安全的组成部分。ClinicalTrials.gov标识符:NCT05446727。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/288e/12339145/eed4b8a02879/PRM2025-8869716.001.jpg

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