切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 617 -620. doi: 10.3877/cma.j.issn.1674-392X.2021.06.018

临床论著

超声引导下腰方肌阻滞与腹横肌平面阻滞技术在腹股沟疝修补术后镇痛中的应用比较
张珏颢1, 张凯2, 杨学林1,()   
  1. 1. 210008 南京大学医学院附属鼓楼医院麻醉科
    2. 210008 南京大学医学院附属鼓楼医院普通外科
  • 收稿日期:2020-12-06 出版日期:2021-12-20
  • 通信作者: 杨学林

Comparison of the postoperative analgesic effects of ultrasound-guided quadratus lumborum block and transversus abdominis plane block after inguinal hernia repair

Juehao Zhang1, Kai Zhang2, Xuelin Yang1,()   

  1. 1. Department of Anesthesiology, The Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing 210008, China
    2. Department of General Surgery, The Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing 210008, China
  • Received:2020-12-06 Published:2021-12-20
  • Corresponding author: Xuelin Yang
引用本文:

张珏颢, 张凯, 杨学林. 超声引导下腰方肌阻滞与腹横肌平面阻滞技术在腹股沟疝修补术后镇痛中的应用比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 617-620.

Juehao Zhang, Kai Zhang, Xuelin Yang. Comparison of the postoperative analgesic effects of ultrasound-guided quadratus lumborum block and transversus abdominis plane block after inguinal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(06): 617-620.

目的

比较腰方肌阻滞与腹横肌平面阻滞在腹股沟疝修补术的术后镇痛效果。

方法

本研究为自身配对、左右对照、双盲研究。选择择期行双侧腹股沟疝修补术患者42例,均为男性,年龄60~80岁,体质量指数21~26 kg/m2,美国麻醉医师协会Ⅰ~Ⅲ级。根据随机数字表分为腰方肌阻滞组(Q组)和腹横肌平面阻滞组(T组)。随机序列数为奇数的患者左侧为腰方肌阻滞组(Q组),右侧为腹横肌平面阻滞组(T组);偶数者右侧为Q组,左侧为T组。Q组行腰方肌阻滞,T组行腹横肌平面阻滞,均给予0.375%罗哌卡因20 ml。所有患者采用相同的全身麻醉方案。记录所有患者的拔管时间、术后2、4、8、12、24、48 h静息和活动时视觉模拟评估法(VAS)评分,补救镇痛使用情况,双侧神经阻滞持续时间。记录血肿、内脏损伤、局部麻醉药中毒、穿刺部位感染等神经阻滞穿刺并发症和恶心呕吐等不良反应发生情况。

结果

与T组比较,Q组患者术后12、24、48 h静息和活动时VAS评分均明显降低(P<0.05),神经阻滞持续时间明显延长(P<0.05)。术后24 h、48 h分别有11例(26.2%)和13例(31.0%)患者需补救镇痛。所有患者均未见血肿、内脏损伤、局部麻醉药中毒、穿刺部位感染等神经阻滞穿刺后并发症,6例(14.3%)患者出现术后恶心呕吐。

结论

Q组可安全应用于腹股沟疝修补术患者,较T组提供更长,术后镇痛效果更好。

Objective

To compare the postoperative analgesic effects of quadratus lumborum block and transversus abdominis plane block in patients undergoing inguinal hernia repair.

Methods

This is a self-matched, left-right control, double-blind study. Forty-two male patients, aged 60 to 80 years, with BMI of 21 to 26 kg/m2, ASA physical status of Ⅰ to Ⅲ, undergoing elective bilateral inguinal hernia repair were enrolled in this study. According to the random number table, they were divided into two groups: quadratus lumborum block group (group Q) and transversus abdominis plane block group (group T). The left side was group Q and the right side was group T when the random number was odd number. Conversely, the left side was group T and the right side was group Q when the random number was even number. Group Q received quadratus lumborum block while group T received transversus abdominis plane block. All the patients were given 20 ml of 0.375% ropivacaine under either of these two nerve blocks. All the patients received the same general anesthesia. The extubation time, visual analogue scale (VAS) at rest and on movement at 2, 4, 8, 12, 24, and 48 hours postoperative, the use of rescue analgesia, the duration of bilateral nerve block were recorded. We also recorded, complications of nerve block such as hematoma, visceral injury, local anesthetic poisoning, infection of puncture site and the incidences of adverse effects such as nausea and vomiting.

Results

The VAS scores at rest and on movement in group Q post-operative 12, 24, 48 h were lower than those in group T (P<0.05). The durations of analgesia were longer in group Q than that in group T (P<0.05). Eleven patients (26.2%) and thirteen patients (31.0%) needed rescue analgesia 24 and 48 h after operation respectively. No complications of nerve block such as hematoma, visceral injury, local anesthetic intoxication, and infection of puncture site were observed in both groups. Six patients (14.3%) suffered from nausea and vomiting after surgery.

Conclusion

The results of this study showed that in patients undergoing inguinal hernia repair, the quadratus lumborum block provided safe, longer and more effective postoperative analgesia compared with the transversus abdominis plane block.

表1 2组患者不同时点VAS评分的比较[分,MQ1Q3)]
[1]
Urits I, Ostling PS, Novitch MB, et al. Truncal regional nerve blocks in clinical anesthesia practice[J]. Best Pract Res Clin Anaesthesiol, 2019, 33(4): 559-571.
[2]
D'Ercole F, Arora H, Kumar PA. Paravertebral block for thoracic surgery[J]. J Cardiothorac Vasc Anesth, 2018, 32(2): 915-927.
[3]
张珏颢,杨学林,张凯. 腹横肌平面阻滞在腹股沟疝修补术患者术后快速康复中的作用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(3): 233-237.
[4]
杨学林,张凯,杜颖, 等. 超声引导下腹横肌平面阻滞对老年腹股沟疝修补术患者术后疼痛的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2017, 11(6): 441-444.
[5]
付越,刘俊艳. 超声引导腹横肌平面阻滞复合右美托咪定对老年腹股沟斜疝手术患者麻醉效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(3): 243-246.
[6]
Wang Y, Wang X, Zhang K. Correction to: effects of transversusabdominis plane block versus quadratuslumborum block on postoperative analgesia: a meta-analysis of randomized controlled trials[J]. BMC Anesthesiol, 2020, 20(1): 128.
[7]
韩彬,王武涛,何爱萍. 超声引导下腰方肌阻滞或腹横肌平面阻滞联合舒芬太尼PCIA在阑尾切除术后镇痛中的比较[J]. 临床麻醉学杂志, 2017, 33(10): 984-986.
[8]
Öksüz G, Bilal B, Gürkan Y, et al. Quadratuslumborum block versus transversusabdominis plane block in children undergoing low abdominal surgery: a randomized controlled trial[J]. RegAnesth Pain Med, 2017, 42(5): 674-679.
[9]
Blanco R, Ansari T, Riad W, et al. Quadratuslumborum block versus transversusabdominis plane block for postoperative pain after cesarean delivery: a randomized controlled trial[J]. Reg Anesth Pain Med, 2016, 41(6): 757-762.
[10]
Verma K, Malawat A, Jethava D, et al. Comparison of transversusabdominis plane block and quadratuslumborum block for post-caesarean section analgesia: a randomised clinical trial[J]. Indian J Anaesth, 2019, 63(10): 820-826.
[11]
Murouchi T, Iwasaki S, Yamakage M. Quadratuslumborum block: analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery[J]. RegAnesth Pain Med, 2016, 41(2): 146-150.
[12]
İpek CB, Kara D, Yılmaz S, et al. Comparison of ultrasound-guided transversusabdominis plane block, quadratuslumborum block, and caudal epidural block for perioperative analgesia in pediatric lower abdominal surgery[J]. Turk J Med Sci, 2019, 49(5): 1395-1402.
[13]
王健. 超声引导下腰方肌阻滞[J]. 岭南现代临床外科, 2017, 17(5): 604-608.
[14]
Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratuslumborum block: an updated review of anatomy and techniques[J]. Biomed Res Int, 2017, 2017: 2752876.
[15]
Dam M, Moriggl B, Hansen CK, et al. The pathway of injectate spread with the transmuscularquadratuslumborum block: a cadaver study[J]. Anesth Analg, 2017, 125(1): 303-312.
[16]
Elsharkawy H, El-Boghdadly K, Kolli S, et al. Injectate spread following anterior sub-costal and posterior approaches to the quadratuslumborum block: a comparative cadaveric study[J]. Eur J Anaesthesiol, 2017, 34(9): 587-595.
[17]
Mirra A, von Rotz A, Schmidhalter M, et al. Ultrasound-guided lateral and subcostal transversusabdominis plane block in calves: a cadaveric study[J]. Vet Anaesth Analg, 2018, 45(3): 384-391.
[18]
李纯青. 腰方肌阻滞的临床应用进展[J]. 临床麻醉学杂志, 2018, 34(6): 616-619.
[19]
Wikner M. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy[J]. Anaesthesia, 2017, 72(2): 230-232.
[1] 宋玟焱, 杜美君, 陈佳丽, 石冰, 黄汉尧. 唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 397-405.
[2] 杜伟, 廖土明, 李雄才, 关刚强, 何燊, 吴佳桥, 朱和荣. 2%利多卡因凝胶和润滑剂凝胶在女性尿流动力学检查中应用的随机对照研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 613-617.
[3] 马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
[4] 王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[5] 周正阳, 陈凯, 仇多良, 邵乐宁, 吴浩荣, 钟丰云. 腹腔镜腹股沟疝修补术后出血原因分析及处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 660-664.
[6] 顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[7] 宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
[8] 高娟, 徐建庆, 闫芳, 丁盛华, 刘霞. Rutkow、TAPP、TEP 手术治疗单侧腹股沟疝患者的临床疗效及对血清炎症因子水平的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 675-680.
[9] 于新峰, 曾琦, 后强, 徐浩, 操谢芳. 腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术对成人腹股沟疝治疗效果及预后分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 681-686.
[10] 方辉强, 黄杰, 随冰琰. 腰方肌阻滞与腹横肌平面阻滞对腹股沟疝腹腔镜手术患者术后镇痛效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 697-702.
[11] 朱佳琳, 方向, 贵诗雨, 黄丹, 周小雨, 郭文恺. 大鼠切口疝腹膜前间隙补片修补术后血清中VEGF 和Ang-1 的表达情况[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 703-707.
[12] 张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.
[13] 杨媛媛, 林贤超, 林荣贵, 陆逢春, 黄鹤光. 肌后/腹膜前补片修补巨大切口疝术后并发症防治[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 645-648.
[14] 韦巧玲, 黄妍, 赵昌, 宋庆峰, 陈祖毅, 黄莹, 蒙嫦, 黄靖. 肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 715-721.
[15] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
阅读次数
全文


摘要