腰方肌阻滞可减轻腹腔镜下肾上腺切除术后患者的疼痛并促进康复:一项随机对照试验

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腰方肌阻滞可减轻腹腔镜下肾上腺切除术后患者的疼痛并促进康复:一项随机对照试验

贵州医科大学麻醉与心脏电生理课题组  

翻译：张中伟 编辑：陈锐 审校：曹莹

HOLIDAY   背景  

探讨腰方肌阻滞(TMQLB)对腹腔镜下肾上腺切除术后患者的疼痛程度、康复情况及患者满意度的影响。

HOLIDAY   方法  

本研究纳入72名年龄在18至70岁之间，ASA I-II，计划行腹腔镜下肾上腺切除术的患者，随机分为两组，行单次腰方肌阻滞，注射药物分别为0.5%罗哌卡因和0.9%生理盐水，剂量均为0.4ml/kg。主要观察结果是在术后12小时，通过数字评分量表（NRS，0-10）评估患者运动时的疼痛程度。我们认为P<0.05具有统计学意义。次要观察结果包括NRS评估的静息痛和运动痛，以及术后康复的相关参数。

HOLIDAY   结果  

与对照组相比，TMQLB组术后12小时的运动NRS评分较低（中位数2 vs. 3，p=0.024），术中芬太尼用量较低（247.08±63.54 vs. 285.44±74.70，p=0.022），术后曲马多的使用率较低（5.6 vs. 27.8%，p=0.027），观察到的恶心和呕吐发生率也较低（11.1 vs. 25%，p=0.220）。TMQLB组患者对镇痛服务的满意度较好（83.3 vs. 25%，p<0.001），卧床休息时间较短（16.5 vs. 21 h，p=0.004），停止排气时间较短（18.5 vs. 23.5 h，p=0.006）。

HOLIDAY 结论

TMQLB能更好地控制腹腔镜下肾上腺切除术后患者的运动疼痛，提高患者的麻醉满意度，缩短卧床休息时间和停止排气时间。

HOLIDAY   原始文献来源  

Qing Yuan, Sufang Lu, Xulei Cui, et al. Transmuscular quadratus lumborumblock for postoperative pain and recovery after laparoscopic adrenalectomy: a randomized controlled trial.[J]. BMC Anesthesiol(2021) 21:274 : 1.

Transmuscular quadratus lumborum

block for postoperative pain and recovery

after laparoscopic adrenalectomy: a randomized

controlled trial

Abstract

Background: To investigate the role of transmuscular quadratus lumborum block (TMQLB) for postoperative pain control, patient satisfaction and recovery in laparoscopic adrenalectomy.

Method:Seventy-two patients aged between 18 and 70 years with an ASA I-II and scheduled for laparoscopic adrenalectomy were randomized to receive a single-shot TMQLB with 0.4 ml/kg 0.5 % ropivacaine or 0.4 ml/kg 0.9 %saline as placebo. The primary endpoint was pain on movement at 12 h after surgery evaluated by the numeric rating scale (NRS, 0–10). P-values < 0.05 was considered statistically significant. The secondary outcomes included pain at rest and pain on movement evaluated by the NRS, and postoperative recovery related parameters.

Results:NRS on movement at 12 h after surgery was lower in the TMQLB group compared with the control (median 2 vs. 3, p = 0.024). Intraoperative fentanyl consumption was lower in the TMQLB group (247.08 ± 63.54 vs.285.44 ± 74.70, p = 0.022). The rate of using postoperative rescue tramadol was also lower in the TMQLB group (5.6 vs. 27.8 %, p = 0.027). Similar incidences of nausea and vomiting were observed (11.1 vs. 25 %, p = 0.220). Patient satisfaction of pain service was better in the TMQLB group (83.3 vs. 25 %, p < 0.001) with shorter time to ambulation (16.5 vs. 21 h, p = 0.004) and flatus (18.5 vs. 23.5 h, p = 0.006).

Conclusion:TMQLB showed better control of postoperative pain on movement for laparoscopic adrenalectomy with improved patients’satisfaction of anesthesia, shorter time to ambulation and flatus.