Comparison of analgesic effect of quadratus lumborum block at the lateral supra‑arcuate ligament and thoracic paravertebral block in laparoscopic cholecystectomy
弓状韧带上腰方肌阻滞与胸椎旁阻滞用于腹腔镜胆囊切除术的镇痛效果比较

摘要

背景：目前关于弓状韧带上腰方肌阻滞的应用报道还比较少，也没有研究比较弓状韧带上腰方肌阻滞与胸椎旁阻滞用于LC手术时，镇痛效果、不良反应、恢复质量的差别及对血流动力学的影响。目的 比较弓状韧带上腰方肌阻滞与胸椎旁阻滞用于腹腔镜胆囊切除术镇痛效果。方法 择期行腹腔镜胆囊切除术的患者60例，随机分为胸椎旁阻滞组（T组，TPVB）和弓状韧带上腰方肌阻滞组（Q组，QLB-LSAL），每组30例。麻醉诱导前在超声引导下T组行右侧TPVB，Q组行右侧QLB-LSAL，各给予0.4%罗哌卡因20ml。记录阻滞操作时间、阻滞平面，术中全麻药物及血管活性药物用量，术毕后不同时间点的HR、MAP、痛觉VAS评分及舒适度BCS评分，术后最早追加镇痛药的时间及总量，术后康复指标及不良反应。结果 Q组穿刺时间少于T组（P＜0. 05），差异有统计学意义，阻滞平面差异无统计学意义。术中全麻药用量及血管活性药用量，术后康复指标及术后不同时间点HR、MAP、疼痛VAS评分和舒适度BCS评分差异无统计学意义。T组7例补救镇痛、1例皮下血肿形成、2例恶心呕吐，Q组4例补救镇痛、2例恶心呕吐。T组补救镇痛率23.3%高于Q组13.3%（P>0.05）。结论 在腹腔镜胆囊切除术中，经弓状韧带上腰方肌阻滞与胸椎旁阻滞的镇痛效果相当，均比较理想，但穿刺时间更短，穿刺风险更低，且补救镇痛率更低，可作为腹腔镜胆囊切除术患者的理想镇痛选择。

Abstract

Background: At present, there are scarce reports on the application of quadratus lumborum block at the lateral supra‑arcuate ligament, and no studies have compared the differences in analgesic effect, adverse reactions, recovery quality, and hemodynamics between quadratus lumborum block at the lateral supra‑arcuate ligament and thoracic paravertebral block in LC surgery. Objective To compare the analgesic effects of the quadratus lumborum block at the lateral supra arcuate ligament and the thoracic paravertebral block in laparoscopic cholecystectomy.
Methods Sixty patients scheduled for abdominal laparoscopic cholecystectomy were randomly divided into the thoracic paravertebral block group (T group, TPVB) and quadratus lumborum block group at the lateral supra‑arcuate ligament (Q group, LSAL), with 30 patients in each group. Before anesthesia induction, the T group received a right TPVB under ultrasound guidance, and the Q group received a right LSAL under ultrasound guidance, each receiving 0.4% ropivacaine 20 ml. The operation time, block level, and amounts of general anesthesia and vasoactive drugs used during the operation were recorded. The HR, MAP, pain VAS score, and comfort BCS score at different time points after the operation, the earliest time of postoperative analgesic drug administration, and the total amount of analgesic drug administration were recorded. The postoperative recovery indicators and adverse reactions were also recorded.
Results The puncture time in the Q group was shorter than that in the T group (P < 0.05), and the difference was statistically significant, while the block level was not statistically significant. The amounts of general anesthesia and vasoactive drugs used during the operation, the postoperative recovery indicators, and the HR, MAP, pain VAS score, and comfort BCS score at different time points after the operation were not statistically significant between the two groups. In Group T, there were 7 cases of remedial analgesia, 1 case of subcutaneous hematoma formation, and 2 cases of nausea and vomiting. Meanwhile, in Group Q, there were 4 cases of remedial analgesia and 2 cases of nausea and vomiting. The rate of remedial analgesia in group T was 23.3% higher than 13.3% in group Q (P>0.05).
Conclusion   In laparoscopic cholecystectomy, the analgesic effects of the quadratus lumborum block at the lateral supra arcuate ligament and the thoracic paravertebral block are equivalent and satisfactory, but the puncture time is shorter, the puncture risk is lower, and the rate of rescue analgesia is lower, making them ideal choices for analgesia in patients undergoing laparoscopic cholecyst.