The Analgesic Effect Of Quadratus Lumborum Block(QLB) In Laparoscopic Hysteromyomectom

BackgroundUterine fibroids are common and frequently occurring diseases in gynecology.Currently,laparoscopic myomectomy is the most commonly used treatment,postoperative pain is still one of the main factors affecting the postoperative rehabilitation of patients with this kind of surgery.Traditional postoperative analgesia mainly depends on patient controlled opioid analgesics via intravenous or epidural administration.However,patients are less satisfied with this traditional method.In order to provide more perfect analgesic effect and reduce adverse reactions,multimodal analgesia the combination of different analgesic methods and analgesics has been advocated in recent years.Lumbar quadratus block means locally injecting anesthetics into the lumbar quadratus with the guidance of ultrasound.The drugs diffuse along the thoracolumbar fascial space and block the anterior branches of lower thoracic and lumbar spinal nerves and sympathetic nerves,alleviating or eliminating abdominal wall pain and visceral pain after abdominal surgery.ObjectiveTo investigate the analgesic effect and the occurrence of nausea and vomiting of lumbar quadratus block in laparoscopic myomectomy.MethodsNinety patients undergone laparoscopic myomectomy and aged from 30 to 50 were selected ASAI-II.Patients were randomly divided into three groups: ultrasound-guided quadratus lumbar block(group Q),ultrasound-guided transversus abdominis plane block(TAPB)(group T),Patient-controlled intravenous analgesia(PCIA)(group P).Group Q received Ultrasound-guided bilateral lumbar quadratus block,Group T received ultrasound-guided bilateral transverse abdominis plane block,Group P was connected with patient-controlled intravenous analgesia pump after operation.VAS scores at 6,12 and 24 hours after operation,number of additional analgesics within 24 hours and the occurrence of nausea and vomiting after operation were recorded.Results1.VAS scores of rest at 6,12 and 24 hours after surgery: No significant difference between the three groups.2.VAS scores of exercise at 6,12 and 24 hours after surgery: One-way analysis of variance indicted significant difference considering all time points(P<0.05).At each time point VAS score of group Q was significant lower compared with group T(P<0.05),while,group Q and group P has no significant difference(P>0.05).3.The rates of additional analgesic drugs within 24 hours after surgery: group Q was13.7%,group T was 50.0%,group P was 14.2%.Significant difference in the three groups(P<0.05).The times of additional analgesic drugs in group Q was significant lower compared with group T(P<0.05),there was no significant difference between Q group and P group(P>0.05).4.The incidence of nausea and vomiting within 24 hours after the surgery: the occurrence rate of group Q was 20.6%,group T was 23.3%,group P was 53.5%.Significant difference in the overall rate(P<0.05).The incidence of nausea and vomiting in group Q was significant lower compared to group P(P<0.05),there was no significant difference between Q group and T group(P>0.05).ConclusionLumbar quadratus block can provide a better analgesic result with a lower incidence of nausea and vomiting after laparoscopic myomectomy.