Clinical Effects Of Quadratus Lumborum Block And Transversus Abdominis Plane Block On Enhanced Recovery After Surgery In Patients Following Laparoscopic Colorectal Surgery

Objectives To study the clinical effects of quadratus lumborum block(QLB)and transversus abdominis plane block(TAPB)on enhanced recovery after surgery(ERAS)in patients following laparoscopic colorectal surgery after general anesthesia.Methods Ninety patients aged from 18 to 75 years old,with ASA physical status I or II,who diagnosed with colon or rectal cancer and scheduled for laparoscopic colorectal surgery were allocated randomly into one of three groups(n=30 for each).The TAPB group received a TAP block prior to general anesthesia with 0.33% ropivacaine 0.4 ml/kg at both side;the QLB group received a QLB prior to general anesthesia with 0.33% ropivacaine 0.4 ml/kg at both side;the control group without performing regional block.In the operating theatre,standard monitoring and bispectral index monitoring were performed and baseline values were recorded.All patients were induced with midazolum 0.05 mg/kg,propofol 1.5-2 mg/kg,sufentanil 0.5 ?g/kg and cisatracurium 0.25 mg/kg.After tracheal intubation,anesthesia was maintained with propofol 4-5 mg/kg·h and remifentanil 0.15 ?g/kg·min.Intraoperative sufentanil 5-10 ?g was given intermittently according to BIS values and hemodynamics changes.Mechanical ventilation was adjusted to maintain an end-tidal carbon dioxide concentration of 35-45 mm Hg and the target range of BIS was 40-55 during maintenance.PCIA pump was applied to all patients when surgery was completed.PCIA pump contained sufentanil(2.5 ?g/kg),tropane 15 mg and normal saline in a total volume of 150 ml,and was set to deliver a bolus dose of 3 ml with 15 min lockout interval with background infusion 1ml/h.Intraoperative dose of propofol,remifentanil and sufentanil,postoperative sufentanil consumption,postoperative visual analogue pain scale(VAS),postoperative flurbiprofen axetil consumption,recovery time of bowel function,ambulation time,length of hospital stay,patient satisfaction and adverse events were recorded.Results Patient demographics for the three groups were comparable.There were no significant differences among the groups in anesthetic time,operation time,dosage of propofol and remifentanl(P > 0.05).Patients in the QLB group and the TAPB group had significantly less sufentanil consumption both intraoperatively and postoperatively when compared with the control group(P < 0.05).The VAS with rest at post 2h,6h and VAS with movement at post 2h,6h,24 h times was significant lower in the QLB group and the TAPB group than that in the control group(P < 0.05).The consumption of flurbiprofen axetil as rescue analgesic was significant lower in the QLB group and the TAPB group when compare with C group(P < 0.05).The recovery time of bowel function,ambulation time,length of hospital stay was shorter and patient satisfaction was higher in the QLB group and the TAPB group when compare with control group(P < 0.05).However,when compared with the TAPB group,total perioperative sufentanil consumption and sufentanil consumption at post 12-24 h period was lower,recovery time of bowel function was shorter in the QLB group(P < 0.05),but there were no significant differences between the two groups in the ambulation time and length of hospital stay(P > 0.05).Conclusion The results showed that QLB and TAPB has significant reductions in perioperative sufentanil consumption and the postoperative pain intensity,as well as shortening recovery time of bowel function,ambulation time and length of hospital stay following laparoscopic colorectal surgery.Compared with the TAPB,QLB has advantage on the reduction of perioperative analgesic consumption and postoperative pain intensity and recovery time of bowel function.