【原】【疼痛专题】超声引导腰方肌阻滞或竖脊肌阻滞进行腹腔镜胆囊切除术的区域镇痛：一项随机对照试验

Regional Analgesia for Laparoscopic Cholecystectomy Using Ultrasound-guided Quadratus Lumborum Block or Erector Spinae Block: A Randomized Controlled Trial

超声引导腰方肌阻滞或竖脊肌阻滞进行腹腔镜胆囊切除术的区域镇痛：一项随机对照试验

论文摘要

Background: Postoperative pain increases the incidence of venous thrombosis and respiratory complications, prevents early postoperative ambulation, and prolongs hospital stay. Fascial plane injections such as erector spinae plane (ESP) block and quadratus lumborum (QL) blocks are popular methods for postoperative pain control and reducing opioid consumption.

背景：术后疼痛会增加静脉血栓和呼吸系统并发症的发生率，妨碍术后早期下床活动，并延长住院时间。筋膜平面注射，例如竖脊肌平面 (ESP) 阻滞和腰方肌 (QL) 阻滞，是术后疼痛控制和减少阿片类药物消耗的常用方法。

Objectives: We aimed to evaluate the analgesic effects of ultrasound-guided ESP versus QL block during laparoscopic cholecystectomy for the reduction of pain and analgesic consumption.

目的：我们旨在评估腹腔镜胆囊切除术中超声引导 ESP 与 QL 阻滞的镇痛效果，以减少疼痛和镇痛药消耗。

Study Design: Prospective, double-blind, single-center, randomized controlled clinical trial.

研究设计：前瞻性、双盲、单中心、随机对照临床试验。

Setting: Minia University Hospital, Minia Governorate, Egypt.

地点：埃及米尼亚省米尼亚大学医院。

Methods: Patients scheduled for laparoscopic cholecystectomy from April 2019 through December 2019 were randomly allocated into 3 groups. After induction of general anesthesia, Group A received an ESP block, group B received a QL block, and group C didn’t receive any block (control). The main outcome was the time to the first analgesic request. Secondary outcomes were the pain intensity measured by the Visual Analog Scale at one, 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively at rest and cough. The total analgesic requirement during the first 24 postoperative hours, hemodynamics, and any complications were recorded.

方法：2019 年 4 月至 2019 年 12 月计划进行腹腔镜胆囊切除术的患者被随机分为 3 组。全身麻醉诱导后，A 组接受 ESP 阻滞，B 组接受 QL 阻滞，C 组不接受任何阻滞（对照组）。主要结果是第一次请求镇痛的时间。次要结果是术后 1、2、4、6、8、12、16、20 和 24 小时休息和咳嗽时通过视觉模拟量表测量的疼痛强度。记录术后前 24 小时内的总镇痛需求、血流动力学和任何并发症。

Results: Sixty patients scheduled for elective laparoscopic cholecystectomy were enrolled; the clinical and demographic data were similar in the 3 groups. Groups A and B had lower VAS scores at cough than Group C in the first postoperative 2 hours. Compared to Group C, a higher score was reported at 8, 12, and 16 hours in Group A, and at 8 and 16 hours in Group B. Group B had a higher score at 4 hours than Group A. At rest, Group C showed higher scores than Groups A and B in the first 2 hours, while higher scores were noted at 16 hours in Group A and 12 hours in Group B. Time to first request of analgesia was significantly prolonged in Group A than in Groups B and C (P < 0.001). Our study showed that Groups A and B had lower postoperative analgesic requirements than Group C (P < 0.05).

结果：60 例计划行择期腹腔镜胆囊切除术的患者入组；三组的临床和人口统计数据相似。术后第一个 2 小时内，A 组和 B 组咳嗽时的 VAS 评分低于 C 组。与 C 组相比，A 组在 8、12 和 16 小时得分较高，B 组在 8 和 16 小时得分较高。B 组在 4 小时得分高于 A 组。休息时，C 组前 2 小时评分高于 A 组和 B 组，而 A 组在 16 小时评分较高，B 组在 12 小时评分较高。A 组首次请求镇痛的时间明显长于 B 组和 C 组（P<0.001）。我们的研究表明，A 组和 B 组的术后镇痛需求低于 C 组（P < 0.05）。

Limitations: This study had a small number of patients enrolled.

Conclusions: Both ESP and QL blocks effectively reduced VAS scores at both cough and rest.There was a decreased total consumption of analgesics in the first postoperative 24 hours with a longer duration of analgesia, which lasted 16 hours in the ESP group and 12 hours in the QL group. 

结论：ESP 和 QL 阻滞均能有效降低咳嗽和休息时的 VAS 评分。术后第一个24小时镇痛药总消耗量减少，镇痛持续时间较长，ESP组持续16小时，QL组持续12小时。

结果展示

Primary and Secondary Outcomes

1. The time to the first analgesic request (Fig. 2) was significantly longer in Group A (13.5 ± 4.5 h) than in Groups B (8.7 ± 4.1 h) and C (1.3 ± 0.4 h) (P < 0.001) . 

A 组首次提出镇痛请求的时间明显长于 B 组和 C 组（P < 0.001）

2. The duration of analgesia was shorter in Group C (1.3 ± 0.4 h) when compared with Group A (11.2 ± 2 h) and Group B (10.0 ± 3.4) (P < 0.001).

持续时间与A组和B组相比，C组镇痛时间较短（P < 0.001）

3. Postoperative fentanyl requirement was higher in group C (98.9 ± 34.1 μg/ kg) than Group A (79.5 ± 21.2) and Group B (83 ± 19.6) with (P = 0.04). C组术后芬太尼需要量高于A组和B组（P=0.04）。

4.Patients in Groups A and B had significantly lower VAS scores at cough than Group C at postoperative hours one and two, while Group B showed higher VAS scores than Group C at postoperative hours 8, 12, and 16. Group A showed higher VAS scores at postoperative hours 8 and 16. At postoperative hour 4, Group B had a significantly higher VAS score than Group A. 

术后第1h和第 2h，A组和B组患者咳嗽时VAS评分显着低于C组，而B组患者在术后第8、12和16 h VAS 评分高于C组。A 组在术后8h和16h表现出较高的VAS评分。术后4h，B组的VAS评分显着高于A组。

5. At rest, Group C showed higher VAS scores than Groups A and B at postoperative hours one and 2. Group B had a higher VAS score than Group A at postoperative 12 hours, while Group A ’s VAS score was higher at postoperative hour 16. 

静息状态下，C组在术后1h和2h的VAS评分高于A组和B组。B组在术后12h的VAS评分高于A组，而A组在术后16h的VAS评分较高。

6. The intragroup comparisons revealed a significant difference in Group A at postoperative hours 4 and 16, 16 hours in Group B and at 6 hours in Group C (P value 0.0001) as seen in Figs. 3 and 4.

组内比较显示，A组在术后4h和16h、B组16h和C组6h有显着差异（P值0.0001）。

7.Postoperative changes in the heart rate (beat/min) in the studied groups.

8. Postoperative changes in mean arterial pressure (MAP) in the studied groups.

使用超声引导腰方肌阻滞或竖脊肌阻滞进行腹腔镜胆囊切除术的区域镇痛：一项随机对照试验.pdf

文章：差劲先生

排版：肉肉