| objective:Laparoscopic hysterectomy is a minimally invasive procedure,but patients experience intense pain during the first 24 hours after surgery.Although patient controlled intravenous analgesia and epidural analgesia can provide good postoperative analgesia,there are often some side effects such as nausea,vomiting,hypotension,and motor block,which are not conducive to postoperative rehabilitation.Quadratus lumborum block is a new trunk nerve block,which can inhibit abdominal wall incision pain and visceral pain.This study was to explore the safety and effectiveness of ultrasound-guided posterior quadratus lumborum block for patients undergoing laparoscopic hysterectomy,so as to provide clinical basis for the application of ultrasound-guided posterior quadratus lumborum block in laparoscopic hysterectomy.Methods:60 patients who were scheduled to laparoscopic hysterectomy with general anesthesia were randomly divided into two groups: posterior quadratus lumborum block combined with general anesthesia group(quadratus lumborum block group,group Q)and simple general anesthesia group(control group,group C),30 patients in each group.patients in group Q received ultrasound-guided bilateral posterior quadratus lumborum block(QLB2)before anesthesia while patients in group C did not receive nerve block.The two groups of patients were given intravenous sufentanil 0.4ug/kg,propofol 1.5mg/kg-2.5mg/kg,and cisatracurium 0.2mg/kg for anesthesia induction.Patients were placed the laryngeal mask after the consciousness disappears,confirm that the laryngeal mask is correct and mechanical ventilation.The anesthesia was maintained with remifentanil,sevoflurane and cisatracurium.After reaching the extubation index,the laryngeal mask was pulled out and the patient was sent to the postanesthesia care unit to continue the resuscitation.The observation data included the general condition of patients,the vital signs during operation,the VAS scores in resting and exercise state at 2h,4h,8h,12 h,and 24 h after operation,the dose of sufentanil at 24 h after operation,the number of people who need postoperative remedial analgesia,the incidence of adverse reactions and satisfactory analgesia,the time of self-breathing recovery and extubation,sedation score leaving the operating room,the time of getting out of bed,the time of exhaust and hospitalization after operation,the Qo R-15 score was tested the 1 day before surgery and 24 hours after surgery.Results:There was no significant difference in general condition between the two groups(P> 0.05).The MAP was higher at T3 and T4 than at T1 in Q group(P<0.05);the MAP was higher at T3,T4 and T5 than at T1 in group C(P<0.05).There was no significant difference in MAP between the two groups at T1,T2,T4,and T5(P>0.05),The MAP of the Q group at T3 was lower than that in C group(P<0.05).The HR at T3 and T4 was significantly different from that at T1 in Q group(P<0.05);The HR at T2,T3,T4 and T5 was significantly different from that at T1 in C group(P<0.05).There was no significant difference in HR between the two groups at T1,T2,and T3(P>0.05),the HR of the Q group at T4 and T5 was lower than that in C group(P<0.05).Compared with group C,the VAS scores of group Q were lower in both rest and exercise state at separate time points after operation(P<0.05);In group Q,the consumption of sufentanil and the incidence of postoperative nausea and vomiting were lower(P<0.05),the postoperative analgesia satisfaction were significantly higher(P<0.05).Compared with group C,the recovery time of self-breathing and extubation time in Q group were lower(P<0.05),and the sedation score leaving the operating room was decreased(P<0.05);the time of getting out of bed and the time of exhaust were lower in the Q group(P<0.05);the recovery quality score after 24 hours were significantly higher in group Q(P<0.05).Conclusions:Posterior quadratus lumborum blockcan maintain relatively stable hemodynamics,shorten spontaneous breathing recovery time and extubation time,provide safe and effective postoperative analgesia and decrease the incidence of adverse reactions for patients undergoing laparoscopic hysterectomy surgery.It can promote the early recovery and improve the quality of postoperative recovery. |
