在过去,腰方阻滞(QLB)主要用于患者的术后镇痛,很少有麻醉师在手术过程中使用无阿片类药物麻醉(OFA)。因此,目前尚不清楚仰卧位的QLB是否能在OFA策略下提供完美的镇痛和抑制麻醉应激。观察超声引导下OFA仰卧位腰方肌阻滞(US-QLB)用于下腹部及盆腔手术的临床疗效。选取2021年3月至2022年7月在万宁市人民医院行下腹部或盆腔手术的患者122例,按随机数字表法分为腰方肌阻滞组(Q组,n=62)和对照组(C组,n=60)。两组均采用仰卧位全麻联合QLB。镇静后,根据手术领域的需要,在局部麻醉下,基于类似于"人眼"和"摇篮中婴儿"的图像,通过超声引导前路进行单侧或双侧QLB.Q组,每侧注射20ml稀释在生理盐水(NS)中的0.50%利多卡因和0.20%罗哌卡因。C组,将20ml的NS注射到每一侧。BP的值,HR,SPO2,SE,RE,SPI,NRS,管家得分,异丙酚的剂量,右美托咪定,和罗库溴铵,需要瑞芬太尼的患者数量,异丙酚,或者地尔硫卓,穿刺点,块平面,麻醉持续时间,导管拔除,并监测手术期间的清醒情况。一般数据无显著差异,需要额外瑞芬太尼的病例数量,异丙酚,或者地尔硫治疗,两组穿刺点和穿刺平面比较(P>0.05)。HR,SBP,T1时Q组DBP值高于C组;HR,SPI,SE,而在T3,SE时,Q组的RE值低于C组,在T4和T5时,Q组Steward评分高于C组,差异有统计学意义(P<0.05)。Q组拔管时间和清醒时间均低于C组,差异有统计学意义(P<0.05)。TheSE,RE,T1、T2、T3和T4时的SPI值低于T0时的SPI值。Q组T4和T5时Steward评分高于C组,均低于T0时,差异有统计学意义(P<0.05)。两组在t1、t3、t4时的术后镇痛效果比较,差异均有统计学意义(P<0.05)。OFA仰卧位的US-QLB对下腹部或骨盆手术患者有效,术中生命体征稳定,完全恢复和更好的术后镇痛。
In the past, quadratus lumborum block (QLB) was mostly used for postoperative analgesia in patients, and few anesthesiologists applied it during surgery with opioid-free anesthesia (OFA). Consequently, it is still unclear whether QLB in the supine position can provide perfect analgesia and inhibit anesthetic stress during surgery under the OFA strategy. To observe the clinical efficacy of ultrasound-guided quadratus lumborum block (US-QLB) in the supine position with OFA for lower abdominal and pelvic surgery. A total of 122 patients who underwent lower abdominal or pelvic surgery in People\'s Hospital of Wanning between March 2021 and July 2022 were selected and divided into a quadratus lumborum block group (Q) (n = 62) and control group (C) (n = 60) according to the random number table method. Both groups underwent general anesthesia combined with QLB in the supine position. After sedation, unilateral or bilateral QLB was performed via the ultrasound guided anterior approach based on images resembling a \"human eye\" and \"baby in a cradle\" under local anesthesia according to the needs of the operative field. In group Q, 20 ml of 0.50% lidocaine and 0.20% ropivacaine diluted in normal saline (NS) were injected into each side. In group C, 20 ml of NS was injected into each side. The values of BP, HR, SPO2, SE, RE, SPI, NRS, Steward score, dosage of propofol, dexmedetomidine, and rocuronium, the number of patients who needed remifentanil, propofol, or
diltiazem, puncture point, block plane, duration of anesthesia, catheter extraction, and wakefulness during the operation were monitored. There were no significant differences in the general data, number of cases requiring additional remifentanil, propofol, or
diltiazem treatment, as well as puncture point and puncture plane between the two groups (P > 0.05). HR, SBP, and DBP values were higher in group Q than in group C at T1; HR, SPI, and SE, while RE values were lower in group Q than in group C at T3, SE, and RE; the Steward score was higher in group Q than in group C at T4 and T5, and the difference was statistically significant (P < 0.05). The extubation and awake times were lower in group Q than in group C, and the difference was statistically significant (P < 0.05). The SE, RE, and SPI values were lower at T1, T2, T3, and T4 than at T0. The Steward scores at T4 and T5 were higher in group Q than in group C, and were lower than at T0, with a statistically significant difference (P < 0.05). There were significant differences in the effectiveness of postoperative analgesia between the two groups at t1, t3 and t4 (P < 0.05). US-QLB in the supine position with OFA is effective in patients undergoing lower abdominal or pelvic surgery with stable intraoperative vital signs, complete recovery and better postoperative analgesia.