Comparison of influence of quadratus lumborum block and transversus abdominis plane block on postoperative analgesia effect in patients with laparoscopic inguinal hernia surgery

doi:10.3877/cma.j.issn.1674-392X.2024.06.020

Abstract

Abstract:

Objective

To compare the influence of quadratus lumborum block (QLB) and transversus abdominis plane block (TAP) on postoperative analgesia effect in patients undergoing laparoscopic inguinal hernia surgery.

Methods

128 patients who underwent elective laparoscopic inguinal hernia surgery from January to December 2022 were selected and divided into QLB group(general anesthesia combined with QLB; n=64) and TAP group (general anesthesia combined with TAP;n=64) according to the random number table method.The heart rate (HR), blood oxygen saturation (SpO₂)and mean arterial pressure (MAP) at different time points, surgical time and nerve block duration were recorded in both groups, and the postoperative visual analogue scale (VAS) score was compared.The postoperative additional analgesic drugs were recorded, and the stress response [cortisol (Cor),norepinephrine (NE), aldosterone (ALD)] before and after surgery and occurrence of adverse reactions were compared between the two groups.

Results

There were no statistically significant differences in HR, SpO₂ and MAP from the aspects of between-group, time-point and interaction effect (P＞0.05).HR,SpO₂ and MAP at T_2-4 in TAP group were lower than those at T₀ (P＜0.05), and HR and MAP at T_1-3 in QLB group were lower than those at T₀, and SpO₂ at T_1-2 was lower than that at T₀ (P＜0.05).The duration of nerve block in QLB group was significantly longer than that in TAP group (P＜0.05), but there was no significant difference in surgical time between the two groups (P＞0.05).There was statistically significant difference in VAS from the aspects of between-group effect, time-point effect and interaction effect between the two groups (P＜0.05).The VAS score in the two groups increased with time from 2 hours to 12 hours after surgery (P＜0.05), and decreased with time from 12 hours to 48 hours after surgery (P＜0.05).VAS scores in QLB group at 4, 8, 12, 24 and 48 hours after surgery were significantly lower than those in TAP group (P＜0.05).The number of cases with additional analgesic drugs in QLB group was significantly less than that in TAP group at 24 and 48 hours after surgery (P＜0.05).The levels of Cor, NE and ALD after surgery increased in both groups (P＜0.05), but the levels in QLB group were significantly lower than those in TAP group (P＜0.05).There was no significant difference in adverse reactions between the two groups(P＞0.05).

Conclusion

Compared with TAP, QLB has better analgesia effect and longer nerve block time,and can reduce the stress response caused by pain stimulation, which is safe and worthy of application..

Key words: Quadratus lumborum block, Transversus abdominis plane block, Hernia,inguinal, Laparoscopes, Analgesia

Huiqiang Fang, Jie Huang, Bingyan Sui. Comparison of influence of quadratus lumborum block and transversus abdominis plane block on postoperative analgesia effect in patients with laparoscopic inguinal hernia surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 697-702.

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Figures/Tables 6

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ±s)	平均病程(年, $\overset{ˉ}{x}$ ±s)	美国麻醉师协会分级[例(%)]			体重指数(kg/m², $\overset{ˉ}{x}$ ±s)
组别	例数	男性	女性	年龄(岁, $\overset{ˉ}{x}$ ±s)	平均病程(年, $\overset{ˉ}{x}$ ±s)	Ⅰ级	Ⅱ级	Ⅲ级	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)
QLB组	64	62(96.87)	2(3.13)	62.33±13.53	1.54±0.37	2(3.13)	51(79.69)	11(17.18)	23.47±1.12
TAP组	64	61(95.31)	3(4.69)	60.36±10.64	1.62±0.40	1(1.56)	50(78.12)	13(20.32)	23.14±1.18
t/χ²值		0.000		0.916	1.175	0.592			1.623
P值		1.000		0.362	0.242	0.554			0.107

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ±s)	平均病程(年, $\overset{ˉ}{x}$ ±s)	美国麻醉师协会分级[例(%)]			体重指数(kg/m², $\overset{ˉ}{x}$ ±s)
组别	例数	男性	女性	年龄(岁, $\overset{ˉ}{x}$ ±s)	平均病程(年, $\overset{ˉ}{x}$ ±s)	Ⅰ级	Ⅱ级	Ⅲ级	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)
QLB组	64	62(96.87)	2(3.13)	62.33±13.53	1.54±0.37	2(3.13)	51(79.69)	11(17.18)	23.47±1.12
TAP组	64	61(95.31)	3(4.69)	60.36±10.64	1.62±0.40	1(1.56)	50(78.12)	13(20.32)	23.14±1.18
t/χ²值		0.000		0.916	1.175	0.592			1.623
P值		1.000		0.362	0.242	0.554			0.107

组别	时间	例数	HR(次/min)	SpO₂(%)	MAP(mmHg)
QLB组		64
	T0		79.24±13.42	99.21±1.25	132.12±24.74
	T1		68.54±8.47^a	99.68±1.53^a	125.64±24.83^a
	T2		65.63±10.35^ab	99.87±1.32^a	118.69±15.47^ab
	T3		66.47±14.32^a	98.95±2.03^bc	124.65±12.64^ac
	T4		77.68±10.14^bcd	99.64±2.14^ad	128.64±19.87^c
TAP组		64
	T0		78.97±12.34	99.78±1.47	135.47±21.36
	T1		67.65±7.54^a	99.89±1.87	127.45±26.35^a
	T2		64.68±9.87^ab	98.78±1.46^ab	121.54±19.78^ab
	T3		63.47±16.18^ab	97.98±1.87^abce	123.64±11.87^ab
	T4		74.34±9.21a^bcd	98.39±2.10^abde	126.64±19.41^ad
F组间值，P组间值			0.23,0.763	0.16,0.892	0.32,0.717
F时间点值，P时间点值			0.38,0.079	0.27,0.164	0.28,0.173
F组间×时间点值，P组间×时间点值			0.43,0.063	0.18,0.854	0.47,0.059

组别	例数	手术时间(min)	神经阻滞持续时间(h)
QLB组	64	68.69±15.68	16.12±1.23
TAP组	64	69.48±14.34	14.12±1.26
t值		0.297	9.087
P值		0.767	＜0.001

组别	例数	术后2 h	术后4 h	术后8 h	术后12 h	术后24 h	术后48 h
QLB组	64	1.57±0.38	1.82±0.32^a	2.16±0.32^ab	2.78±0.34^abc	2.46±0.35^abcd	2.34±0.38^abcde
TAP组	64	1.60±0.34	2.03±0.28^a	2.57±0.26^ab	3.04±0.36^abc	2.64±0.31^abcd	2.51±0.42^abcde
t值		0.471	3.951	7.955	4.201	3.080	2.401
P值		0.639	＜0.001	＜0.001	＜0.001	0.003	0.018
F组间值,P组间值		F=2.48,P＜0.001
F时间点值,P时间点值		F=54.08,P＜0.001
F组间×时间点值,P组间×时间点值		F=0.74,P0.026

组别	例数	术后12 h	术后24 h	术后48 h
QLB组	64	4(6.25)	7(10.94)	9(14.06)
TAP组	64	11(17.19)	16(25.00)	19(29.69)
χ²值		3.700	4.293	4.571
P值		0.054	0.038	0.033

组别	例数	Cor(nmol/L)		NE(μg/L)		ALD(ng/dl)
组别	例数	术前	术后24 h	术前	术后24 h	术前	术后24 h
QLB组	64	204.64±13.84	218.69±14.47^a	65.36±5.47	85.69±7.31^a	8.14±1.36	14.47±2.42^a
TAP组	64	202.69±12.87	242.65±12.68^a	64.78±4.89	97.58±6.44^a	8.44±1.24	17.87±2.69^a
t值		0.825	9.963	0.632	9.764	1.304	7.517
P值		0.411	＜0.001	0.528	＜0.001	0.195	＜0.001

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