Abstract:

Objective　To explore the effect of ultrasound-guided quadratus lumborum block (QLB) in laparoscopic and colorectal surgery and its influence on the scores of Visual Analogue Scale (VAS) 4, 6, 12, and 24 h after surgery. Methods　One hundred and twenty-one patients undergoing laparoscopic and colorectal surgery at First Hospital, Nanyang Medical College from October 2020 to July 2022 were selected as the research objects for prospective study. After analyzing the patients' medical records, the patients were divided into an observation group (61 cases) and a control group (60 cases) according to the different anesthesia schemes. There were 34 males and 27 females in the observation group who were (51.27±3.49) years old. There were 32 males and 28 females in the control group who were (51.52±3.13) years old. The observation group received QLB, and the control group received transverse abdominal muscle block (TAP). The VAS scores of incision pain and visceral pain 4, 6, 12, and 24 h after the operation, block-related indicators, and adverse reactions were compared between the two groups. t and χ² tests were applied. Results　There were no statistical differences in the amounts of fluid and blood loss between the two groups (both P>0.05). While the intraoperative dosages of sufentanil and remifentanil were the same, the total consumptions of sufentanil and remifentanil in the observation group were significantly lower than those in the control group [(185.74±13.32) μg vs. (204.37±13.67) μg and (947.42±82.25) μg vs. (1 525.28±125.34) μg], with statistical differences (t=7.593 and 30.030; both P<0.05). The incidence of adverse reactions during analgesia in the observation group was lower than that in the control group [3.28% (2/61) vs. 15.00% (9/60)], with a statistical difference (χ²=5.028, P=0.025). There were no statistical differences in the VAS scores of incision pain after the operation between the two groups (all P>0.05). The VAS scores of visceral pain 4, 6, 12, and 24 h after the operation in the observation group were lower than those in the control group [(1.79±0.11) vs. (5.83±0.51), (1.58±0.11) vs. (5.64±0.53), (1.54±0.13) vs. (4.55±0.40), and (1.31±0.10) vs. (3.91±0.38)], with statistical differences (t=60.460, 58.565, 55.853, and 37.350; all P<0.05). Conclusion　QLB has a significant clinical effect in laparoscopic colorectal surgery, and can effectively improve postoperative visceral pain scores and reduce the dosage of analgesics and adverse reactions, so it is worthy of clinical promotion.

Key words:

Quadratus lumbar muscle block, Laparoscopic colorectal surgery, Ultrasound-guided, Postoperative pain

摘要：

目的　探析超声引导下腰方肌阻滞（QLB）应用于腹腔镜结直肠手术及对术后4、6、12、24 h视觉模拟评分（VAS）的影响。方法　选择南阳医学高等专科学校第一附属医院2020年10月至2022年6月收治的行腹腔镜结直肠手术的121例患者进行前瞻性研究，分析患者的病历资料后根据麻醉方案的不同将患者分为两组。观察组（61例），男34例、女27例，年龄（51.27±3.49）岁，实施QLB；对照组（60例），男32例、女28例，年龄（51.52±3.13）岁，实施腹横肌阻滞（TAP）。对比两组术后4、6、12、24 h的切口痛及内脏疼痛评分、阻滞相关指标、不良反应。统计学方法采用t检验、χ²检验。结果　两组术中补液量、失血量差异无统计学意义（P>0.05）；而舒芬太尼、瑞芬太尼术中用量一致前提下，观察组舒芬太尼总消耗量为（185.74±13.32）μg，明显低于对照组的（204.37±13.67）μg，观察组瑞芬太尼总消耗量为（947.42±82.25）μg，明显低于对照组的（1 525.28±125.34）μg，差异均有统计学意义（t=7.593、30.030，均P<0.05）。观察组镇痛期间不良反应率［3.28%（2/61）］明显低于对照组［15.00%（9/60）］，差异有统计学意义（χ²=5.028，P=0.025）。术后两组不同时间点切口痛VAS评分差异均无统计学意义（均P>0.05）；观察组术后4、6、12、24 h内脏痛VAS评分分别为（1.79±0.11）分、（1.58±0.11）分、（1.54±0.13）分、（1.31±0.10）分，对照组术后4、6、12、24 h内脏痛VAS评分分别为（5.83±0.51）分、（5.64±0.53）分、（4.55±0.40）分、（3.91±0.38）分，两组比较差异均有统计学意义（t=60.460、58.565、55.853、37.350，均P<0.05）。结论　QLB应用于腹腔镜结直肠手术临床效果显著，可有效改善术后内脏疼痛评分、减少镇痛药物用量、降低不良反应，值得临床推广。

关键词:

腰方肌阻滞, 腹腔镜手术, 超声引导, 术后疼痛