开腹子宫手术中腰方肌阻滞和硬膜外阻滞镇痛效果的比较：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：李奕 编辑：潘志军 审校：曹莹
背景：开腹手术中有效的局部镇痛可以减少阿片类药物的消耗，促进早期康复。我们比较了腰方肌阻滞（QLB）和传统的硬膜外阻滞（EB）在开腹子宫手术中的效果。
方法：在这项随机对照试验中，我们纳入了计划于2019年5月至9月30日进行择期开腹子宫手术的患者。患者在全身麻醉前接受QLB或EB用于围手术期镇痛。围手术期阿片类药物消耗量、术后疼痛评分（NRS:0-10）、心率（HR）、平均动脉压（MAP）、术中麻黄碱和乌拉地尔的使用、下肢肌肉力量、术后24小时内第一次排气和排便的时间、恶心、呕吐和其他并发症分别是主要和次要结果。
结果：对83例符合条件的患者中72例（86%；36/组）的数据进行了分析。QLB组手术期间的瑞芬太尼消耗量高于EB组，而两组术后24小时内的累积舒芬太尼消耗量相似。术后1小时，QLB组静息和活动时的NRS疼痛评分较高，术后5、15和30分钟的MAP高于EB组；各组之间的HR相似。QLB组术后1小时麻黄碱需求量较低，下肢肌肉力量较高，恶心发生率较低。
结论：与EB相比，QLB在开腹子宫手术后的前24小时产生的阻滞强度更小，但阻滞时间更长，副作用更少。
原始文献来源：
Huiyu She , Peng Jiang , Juan Zhu, et al. Comparison of the analgesic effect of quadratus lumborum block and epidural block in open uterine surgery: a randomized controlled trial.[J].Minerva Anestesiol. 2021 Apr;87(4):414-422.
Comparison of the analgesic effect of quadratus lumborum block and epidural block in open uterine surgery: a randomized controlled trial
Abstract
Background:Effective regional analgesia during open surgery could reduce opioid consumption and enhance early recovery. We compared the effects of the newly developed quadratus lumborum block (QLB) and the traditional epidural block (EB) in open uterine surgery.
Method:In this randomized controlled trial, we included patients scheduled for elective open uterine surgery during May - September 30, 2019. Patients received QLB or EB for perioperative pain relief before general anesthesia. Perioperative opioid consumption, and numeric rating scale (NRS: 0-10) pain scores after surgery, heart rate (HR), mean arterial pressure (MAP), ephedrine and urapidil use during surgery, lower limb muscle strength, timing of first flatus and defecation, nausea, vomiting, and other complications within 24 h post-surgery, were the primary and secondary outcomes, respectively.
Results:Data of 72 (86%; 36/group) of 83 eligible patients were analyzed. Remifentanil consumption during surgery was higher in the QLB than in the EB group, while cumulative sufentanil consumption within 24 h post-surgery was similar between both groups. NRS pain scores at rest and during activity were higher at 1 h post-surgery, and MAP was higher at 5-, 15-, and 30-min postincision in the QLB than in the EB group; HR was similar between groups. Lower ephedrine requirements, higher lower limb muscle strength at 1 h post-surgery, and lower nausea incidence were observed in the QLB group.
Conclusion:QLB produces a less intense but longer block and fewer side effects in the first 24 h after open uterine surgery than those produced by EB.
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