Application Of Quadratus Lumborum Block Versus Transversus Abdominis Plane Block In Fast Recovery After Laparoscopic Hysterectomy

Objective:To compare the fast recovery effect of ultrasound-guided Quadratus Lumborum Block?QLB?and Transversus Abdominis Plane Block?TAPB?combined with general anesthesia in laparoscopic uterine surgery.Methods:Totally,80 patients with ASA I-?aged 18-65 years underwent elective laparoscopic gynecological uterine surgery under general anesthesia were selected.All the recruited patients volunteered and signed the informed consent,which was in accordance with the ethics.The study subjects were randomly divided into two groups by random number table,40 cases in each group,including 40 cases in QLB group?Q group?and 40 cases in TAPB group?T group?.Subjects in the two groups underwent ultrasound-guided QLB and ultrasound-guided TAPB according to the groups before the implementation of general anesthesia:group Q received 20 mL of0.375%Ropivacaine on both sides of the anterior QLB;group T received 20 mL of0.375%Ropivacaine on both sides of the bilateral posterior TAPB.After successful nerve block,all subjects routinely underwent general anesthesia with endotracheal intubation to complete the operation.At the end of the operation,patients were given“background infusion+single dose”intravenous patient-controlled analgesia?PCIA?.Real-time data such as mean arterial pressure?MAP?,pulse oxygen saturation?SpO₂?and heart rate?HR?were recorded at admission?T₀?,immediately before skin incision?T₁?,1 min after skin incision?T₂?,5 min after skin incision?T₃?and at the end of surgery?T₄?,and the relevant differences?MBP,?SpO₂ and?HR at different time points were calculated;the total duration of surgical anesthesia was recorded;the use of various anesthetic drugs during surgery was counted;the length of stay in the postanesthesia care unit?PACU?and the total time of endotracheal tube removal were recorded;the resting and motor visual analogue scale?VAS?score at each time period?2 h,4 h,8 h,24 h and 48 h after surgery,i.e.,T₅,T₆,T₇,T₈ and T₉?was recorded,and the total use of postoperative Sufentanil,the first compression time of analgesic pump and the total number of compressions,the anus exhaust time,the first ambulation time,postoperative satisfaction score,postoperative additional analgesia and the incidence of postoperative adverse reactions?nausea and vomiting,dizziness,skin itching,etc.?;record the total hospital stay of patients and postoperative discharge time.Results:The additional amount of sufentanil during surgery were significantly less in group Q than in group T?P<0.05?.?MBP_T2-T1,?HR_T2-T1,?MBP_T3-T1,and?HR_T3-T1were significantly smaller in group Q than in group T?P<0.05?.Patients in group Q had significantly lower resting and motor VAS scores at 2 h,4 h,8 h,24 h,and 48 h after surgery than patients in group T?P<0.05?.The first postoperative anus exhaust time,the first ambulation time and the eating time of patients in group Q were significantly shorter than those of patients in group T?P<0.05?.Postoperative satisfaction was better in group Q than in group T?P<0.05?.There were no significant differences in age,height,weight,BMI and ASA grade between the two groups?P>0.05?.There was no significant difference in admission MAP,SpO₂,HR,operation time,intake and output,and intraoperative use of remifentanil,Atropium,and cisatracurium between the two groups?P>0.05?.There was no significant difference in?MBP_T1-T0,?SpO_2T1-T0,?HR_T1-T0,?SpO_{2 T2-T1},?SpO_{2 T3-T1},?MBP_T4-T1,?SpO_{2 T4-T1},and?HR_T4-T14-T1 between the two groups of patients?P>0.05?.There was no significant difference between the total dose of sufentanil used for PCIA within 24hours and the second 24 hours after operation?P>0.05?.There was no significant difference in postoperative endotracheal tube extubation time,PACU stay,additional analgesia and adverse reactions between the two groups?P>0.05?.Conclusion:Compared with TAPB,ultrasound-guided QLB can reduce the perioperative opioid dosage in patients undergoing laparoscopic gynecological uterine surgery,better maintain intraoperative hemodynamic stability,shorten the postoperative first anus exhaust time,the first ambulation time,eating time,accelerate turnover,which is more conducive to rapid recovery of patients.The application of general anesthesia combined with ultrasound-guided quadratus lumborum nerve block in laparoscopic uterine surgery is worthy of promotion in clinical work.