Quadratus lumborum block for postoperative pain after caesarean section A randomised controlled trial
Quadratus lumborum block for postoperative pain after caesarean section A randomised controlled trial
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DOI：
10.1097/eja.0000000000000299
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发表时间：
2015-11-01
影响因子：
3.6
通讯作者：
Girgis, Emad
中科院分区：
文献类型：
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作者：
Blanco, Rafael;Ansari, Tarek;Girgis, Emad
背景剖腹产术后有效的术后镇痛非常重要，因为它可以实现早期下床活动并促进母乳喂养。一些病例报告表明，在腰方肌周围注射局部麻醉剂可以有效缓解各种腹部手术后和慢性疼痛患者的疼痛。腰方肌阻滞 (QLB) 在靠近表面的位置进行，并使用筋膜室路径将局部麻醉的分布延伸到后腹壁和椎旁间隙。这种中心效应在处理剖腹产后内脏疼痛时至关重要。目的我们假设剖腹产后 QLB 作为多模式方法的一部分可以提供足够的疼痛缓解。设计双盲、随机和对照临床试验。设置 2014 年 6 月至 2014 年 12 月之间的单一中心。患者 50 名美国麻醉医师协会身体状况 1 或 2 级且正常的患者妊娠至少 37 周并计划在脊髓麻醉下进行选择性剖腹产的单胎妊娠被纳入该研究。他们被随机分配接受含有 0.125% 布比卡因 0.2 ml kg(-1) 的 QLB (n = 25)（第 1 组）或含有 0.9% 生理盐水 0.2 ml kg(-1) 的 QLB (n = 25)（第 2 组）。 主要结果指标 该研究的主要结果指标是患者自控镇痛系统提供的吗啡需求和剂量手术后按预定时间间隔（1、2、4、6、12、24 和 48 小时）进行。次要终点是静息和运动时疼痛（动态）的视觉模拟量表（VAS）、心率、血压、瘙痒、瘙痒、恶心、呕吐和镇静。 结果 接受局麻药的患者在剖腹产后 6 小时和 12 小时使用的吗啡显着少于对照组（P < 0.001），但在剖腹产后 24 小时和 48 小时则不然。剖腹产后6、12、24、48 h，局麻组吗啡需求量显着低于对照组（P < 0.001）。局麻组的VAS显着低于对照组，包括剖腹产后除24小时外所有时间的静息疼痛VAS，以及所有时间的运动（动态）疼痛VAS。结论剖腹产后QLB是有效的，并与典型的术后镇痛方案相结合，提供了满意的镇痛效果。
BACKGROUND Effective postoperative analgesia after caesarean section is important because it enables early ambulation and facilitates breast-feeding. Several case reports have shown that local anaesthetic injection around the quadratus lumborum muscle is effective in providing pain relief after various abdominal operations and in patients with chronic pain. The quadratus lumborum block (QLB) is performed in close proximity to the surface and uses a fascial compartment path to extend the distribution of local anaesthesia into the posterior abdominal wall and paravertebral space. This central effect can be of vital importance when managing the visceral pain after caesarean section.OBJECTIVE We hypothesised that the QLB after caesarean section can provide adequate pain relief as part of a multimodal approach.DESIGN Double-blind, randomised and controlled clinical trial.SETTING A single centre between June 2014 and December 2014.PATIENTS Fifty patients who were American Society of Anesthesiologists physical status 1 or 2, with normal singleton pregnancies with a gestation of at least 37 weeks, and scheduled for elective caesarean section under spinal anaesthesia, were enrolled into the study. They were randomly assigned to receive a QLB (n = 25) with 0.125% bupivacaine 0.2 ml kg(-1) (Group 1) or a QLB (n = 25) with 0.9% Normal saline 0.2 ml kg(-1) (Group 2).MAIN OUTCOME MEASURES The primary outcome measure for the study was the morphine demands and doses delivered by a patient-controlled analgesia system at predetermined intervals (1, 2, 4, 6, 12, 24 and 48 h) after surgery. The secondary endpoints were visual analogue scale (VAS) for pain at rest and on movement (dynamic), heart rate, blood pressure, pruritus, itching, nausea, vomiting and sedation.RESULTS The patients who received local anaesthetic used significantly less morphine than the control group (P < 0.001) at 6 and 12 h, but not at 24 and 48 hours after caesarean section. The local anaesthetic group had significantly less morphine demand than the control group (P < 0.001) 6, 12, 24 and 48 h after caesarean section. The VAS was significantly lower in the local anaesthetic group than the control group, including VAS for pain at rest at all times except 24 h after caesarean section, and VAS for pain on movement (dynamic) at all times.CONCLUSION The QLB after caesarean section was effective and provided satisfactory analgesia in combination with a typical postoperative analgesic regimen.