【经典高分文献阅读】全髋关节置换术中腰方肌阻滞中的作用:一项随机对照试验

Editor’s Perspective

What We already Know about This Topic

•Early mobilization after joint replacement surgery requires effective analgesia

•Interfacial plane injections including quadratus lumborum block have been advocated for pain relief after hip joint replacement, but evidence for this approach is sparse.

•关节置换术后早期活动需要有效的镇痛

•包括腰方肌阻滞在内的界面平面注射被提倡用于髋关节置换术后的疼痛缓解，但这种方法的证据很少

What This article Tells Us That Is New

• In the context of a multimodal postoperative analgesic strategy, providing a quadratus lumborum block using ropivacaine resulted in no less morphine consumption or pain in the first 24 postoperative hours compared to saline injection

• Quadratus lumborum block also provided no advantages in terms of time to first standing, ambulation, or hospital stay

•在多模式术后镇痛策略的背景下，与生理盐水注射相比，罗哌卡因腰方肌阻滞术后24小时吗啡用量及疼痛程度未减少

•腰方肌阻滞在首次站立、行走或住院时间方面也没有优势

Background:

Pain management is important for ensuring early mobilization after hip arthroplasty; however, the optimal components remain controversial. Recently, the quadratus lumborum block has been proposed as an analgesic option. The current study tested the hypothesis that the posterior quadratus lumborum block combined with multimodal analgesia decreases morphine consumption after hip arthroplasty.

疼痛管理对保证人工髋关节置换术后早期动员有重要意义；然而，最优方式仍然存在争议。近年来，腰方阻滞被认为是一种镇痛的选择。本研究证实了腰四方阻滞联合多模式镇痛降低人工髋关节置换术后吗啡消耗的假设。

Methods:

This study was a prospective, randomized, double-blind, placebo-controlled trial. Before general anesthesia, 100 participating patients scheduled for elective total hip arthroplasty were randomly allocated to receive a 30-ml injection posterior to the quadratus lumborum muscle with either 0.33% ropivacaine (n = 50) or normal saline (n = 50). For all patients, multimodal analgesia included systematic administration of acetaminophen, ketoprofen, and a morphine intravenous patient-controlled analgesia. The primary outcome was total intravenous morphine consumption in the first 24 h. Secondary outcomes recorded intraoperative sufentanil consumption; morphine consumption in the postanesthesia care unit; pain scores at extubation and at 2, 6, 12, and 24 h; motor blockade; time to first standing and ambulation; hospital length of stay; and adverse events.

本研究是一项前瞻性、随机、双盲、安慰剂对照试验。全麻前，随机分配100名计划进行全髋关节置换术的参与患者，在腰方肌后30ml注射0.33%罗哌卡因（n=50）或生理盐水（n=50）。对所有患者，多模式镇痛包括系统给药对乙酰氨基酚、酮洛芬和吗啡静脉自控镇痛。最初的结果是在头24小时内静脉注射吗啡总量。术中舒芬太尼消耗量记录的次要结果；术后护理单位吗啡消耗；拔管时疼痛评分，2、6、12和24 h；电机封锁；第一站和走动的时间；住院时间；以及不良事件。

Results:

There was no significant difference in the 24-h total morphine consumption (ropivacaine group, median [interquartile range], 13 [7 to 21] versus saline group, 16 [9 to 21] mg; median difference, -1.5; 95% CI, -5 to 2; P = 0.337). Pain scores were not different between the groups (β = -0.4; 95% CI, -0.9 to 0.2; P = 0.199). There was no statistical difference between the two groups in intraoperative sufentanil consumption, morphine consumption in the postanesthesia care unit, motor blockade, times to first standing (median difference, 0.83 h; 95% CI, -1.7 to 3.4; P = 0.690) and ambulation (median difference, -1.85 h; 95% CI, -4.5 to 0.8; P = 0.173), hospital length of stay, and adverse events.24小时吗啡总消耗量（罗哌卡因组，中位[四分位数范围]，13[7-21]与生理盐水组相比，16[9-21]mg无显著性差异；中位数差，-1.5；95%CI，-5至2；P=0.337）。两组疼痛评分无差异(β = -0.4; 95%CI，-0.9至0.2；P=0.199）。两组术中舒芬太尼用量、术后护理单位吗啡消耗、运动阻滞、首次站立次数无统计学差异（中位数差异0.83h）；95%CI，-1.7至3.4；P=0.690）和移动（中位数差，-1.85 h；95%CI，-4.5至0.8；P=0.173）、住院时间和不良事件。

Conclusions:

After elective hip arthroplasty, neither morphine consumption nor pain scores were reduced by the addition of a posterior quadratus lumborum block to a multimodal analgesia regimen

选择髋关节置换术后，在多模式镇痛方案中加入腰方肌阻滞，吗啡消耗量和疼痛评分均未降低