Ultrasound-guided Quadratus Lumborum Block Combined With Rectus Sheath Block For Postoperative Analgesia In Open Hepatobiliary Surgery

Objective:To observe the effects of ultrasound-guided quadratus lumborum block combined with rectus sheath block on postoperative analgesia in patients undergoing open hepatobiliary surgery,provide reference for postoperative analgesia of patients.Methods:Eighty-four patients who underwent elective open hepatobiliary surgery with ASA Ⅰ-Ⅱ grade in our hospital from December 2017 to December 2019 were selected.These cases were randomly divided into 4 groups,21 cases in each group.After the patient entered the operating room,the basic vital signs were routinely monitored,and the intravenous access was then opened.The plan of anesthesia induction and maintenance of anesthesia were identical.After the operation,the ultrasound-guided nerve block was performed immediately.In Group R,an ultrasound-guided rectus sheath block was performed on the upper and inner sides of the surgical incision bilaterally.Inject 10ml of 0.25%ropivacaine at each location,four injection sites on both sides,a total of 40 ml.In Group Q,an ultrasound-guided quadratus lumbar block was performed on bilaterally,injecting 20ml of 0.25%ropivacaine at each side,a total of 40ml.In the Group Q+R,ultrasound-guided bilateral quadratus lumbar block combined with a rectus sheath block is done.The blocking methods were the same as above.After the operations,all patients received the same medication,dose and injection parameters of PCIA pumps.Observe and record the time of operation,the amount of blood loss during the operation,the time of staying post-anesthesia care unit,the day of first postoperative ambulation,the length of hospital stay,the time of the first compression on the PCIA pump,the number of effective analgesia pump compressions 24h after operation,additional analgesics(hydromorphone lmg)times in the 24 hours after operation,postoperative adverse events(such as nausea,vomiting,hypotension,etc.),the satisfaction scores of the patient,the Ramsay scores,rest and cough VAS scores at 2h,6h,12h and 24h after the operation.Results:1.The time of staying in post-anesthesia care unit in Group Q+R and Group Q was significantly shorter than Group P(P<0.005);the day of first postoperative ambulation of Group Q+R was significantly less than other 3 groups(P<0.05);the length of hospital stay of Group Q+R was significantly less than Group R and Group P(P<0.05)2.The time of the first compression of the PCIA pump of Group Q+R was significantly prolonged than Group P and Group R(P<0.05);3.The number of effective analgesia pump compressions in the 24h hours after the operation of Group Q+R was significantly lower than the other 3 groups(P<0.05);4.The times of additional analgesics in 24h after operation of Group Q+R was significantly less than those in Group P and Group R(P<0.05);5.The VAS scores at rest and cough of Group Q+R were significantly lower than those in the other 3 groups at the same time points.(P<0.05)6.The Ramsay scores at the 2h,6h,and 12h of Group Q+R were significantly higher than those in Group P at the same time points.(P<0.01).No significant differences of Ramsay scores at the same time points of Group Q+R,Group Q and Group R(P>0.05);7.The satisfaction scores of the patient of Group Q+R were significantly better than those in the other 3 groups(P<0.01);8.The rates of nausea and vomiting of Group P were significantly higher than those in the other 3 groups(P<0.05).Except for nausea and vomiting,there was no significant difference in the incidence of other adverse events among the groups(P>0.05).Conclusions:Ultrasound-guided quadratus lumborum block combined with rectus sheath block could improve the postoperative analgesic effect of open hepatobiliary surgery,reduce opioids use,and not increase the incidence of adverse events.