Comparison Of Ultrasound-guided Posterior Quadratus Lumborum Block With Posterior Transversalis Abdominis Plane Block In Analgesic Effects After Cesarean Section

Objective:To compare the postoperative analgesic effects between posterior quadratus lumborum block and posterior transverse abdominal plane block in patients underwent cesarean sections,so as to find out the better perioperative balanced analgesia method for clinicians.Methods:This study was conducted in The peoples hospital of YUDU coumtry from September 2019 to February 2020.Ninety parturients underwent cesarean sections were randomly allocated into three equal groups.The patients in group I were given posterior quadratus lumborum block combined with patient controlled intravenous analgesia(PCIA)for postoperative analgesia,the patients in group II were given TAP(posterior approach)combined with PCIA,while the patients in group III were only given PCIA.A continuous sulfentanil(2 ?g/h)was infused postoperatively through a analgesia pump with bolus of sulfentanil(3 ?g)and lockout time being 15 min as analgesic rescue.Primary outcome measures were Visual analogue scale(VAS)scores of the pain of surgical incision and uterine contraction at 6h,12 h and 24 h after cesarean section.Secondary outcome measures were the levels of cortisol pre-operation and 6h,12 h,24h after cesarean section,the adverse effects(such as nausea,vomiting,urine retention and numbness of lower limbs),and the degree of satisfaction on postoperative analgesia in these parturients.Results:1.Comparison of the VAS scores of postoperative incision pain and uterine contraction pain:The VAS scores of those pain in group I were significantly lower than those in group II and group III(P<0.01).Besides,those in group II were significantly lower than group III(P<0.01).2.Comparison of the plasma cortisol levels at T0(before surgery),T1(6 hours after surgery),T2(12 hours after surgery)and T3(24hours after surgery):There was a certain increase in cortisol concentr-ation in the three groups after surgery.Compared with Group II and Group III,the plasma cortisol levels in Group I had the lowest increase(P<0.05).3.Comparison of the effective compression times of analgesia pump and the dosage of sufentani:The effective compression times of analgesia pump and the dosage of sufentanil of contractile pain in group I were significantly lower than those in group II and group III(P<0.05).Besides,those in group II were lower than group III(P<0.05).4.Comparison of the incidence of adverse reactions and the analgesic satisfaction: The incidence of adverse reactions and the analgesic satisfaction in group I were lower than those in group III(P<0.05);There were no significant difference in adverse reactions between group II and group III(P>0.05).Conclusion:1.Compared with posterior transverse abdominal plane block combined with intravenous analgesia,ultrasound guided posterior lumbar muscle block combined with intravenous analgesia provides better analgesic effects of incision and uterine contraction,significantly reduces the consumption of opioids,as well as decreases the secretion of cortisol hormone and reduce the stress response.2.Compared with control group(group III),the VAS scores of incision and uterine contraction pain and the rate of adverse effects were decreased in combined analgesia group(group I and II),while the degree of satisfaction in parturients were improved.