Efficacy Of Quadratus Lumborum Block With Different Concentrations Of Ropivacaine For Analgesia After Percutaneous Nephrolithotomy

Objective:To investigate the effect of different concentrations of ropivacaine for ultrasound-guided anterior quadratus lumborum block on the analgesic effects of patients undergoing percutaneous nephrolithotomy and early postoperative rehabilitation,and to further evaluate the quadratus lumborum block at the feasibility,safety and effectiveness of the application of stagnation analgesia under the concept of perioperative enhanced recovery after surgery,in order to provide reference and clinical basis for the perioperative analgesia of patients with percutaneous nephrolithotomy.Methods:One hundred and twenty of both sexes,aged 35-70 yr,with body mass index of 18-25kg/m~2,of American Society Anesthesiologists physical statusⅠorⅡ,scheduled for elective percutaneous nephrolithotomy under general anesthesia.120 patients were randomly divided into 3 groups(n=40 in each group):0.25%ropivacaine group(R25 group),0.375%ropivacaine group(R375 group)and 0.50%ropivacaine group(R50 group).Before induction of general anesthesia,the anterior quadratus lumborum block was guided by ultrasound and injected 0.25%,0.375%,0.50%ropivacaine 30ml according to the group.Within 2 days after surgery,ketorolac tromethamine 30 mg was injected intravenously bid,and if necessary,5 mg dezocine was injected intravenously for remedial pain.Monitor and record the following data:(1)Record the general information of all patients;(2)Record the VAS scores at rest and activity at 2h,6h,12h,24h,48h after surgery;(3)Record the intraoperative VAS score The hemodynamic changes at different time points are the mean arterial pressure difference between the completion of the lithotripsy channel(T1),1h after the start of the operation(T2),the end of the operation(T3)and immediately before the start of the operation(T0)(△MBP)and heart rate difference(△HR);(4)Record the total amount of propofol and Refine infusion,postoperative salvage analgesia rate and analgesia satisfaction;(5)Record extubation time and time out of PACU,First exhaust time and first time to get out of bed;(6)Observe the occurrence of adverse reactions and block-related complications within 48 hours after surgery.Results:Compared with the R25group,the rest and exercise VAS scores of the R375 group and the R50 group were significantly lower at 2h,6h,12h,and 24h after the operation(P<0.05).There was no significant difference in the resting and exercise VAS scores from2h to 24h after the operation(P>0.05).Compared with the 2h to 24h after the operation,the three groups’resting and exercise VAS scores were 48h after the operation.Significantly reduced(P<0.05).Compared with the R25 group,the△MBP and△HR at T1 of the R375 group and the R50 group were significantly reduced(P<0.05),and at T2 and T3,there was no statistical difference in△MBP and△HR between the three groups(P>0.05);Compared with T1,△MBP and△HR at T2-3 in R25 group were significantly reduced(P<0.05);There was no significant difference in△MBP and△HR at T1-3 between R375 group and R50 group(P>0.05).Compared with the R25 group,the total amount of remifentanil infusion and the postoperative salvage analgesia rate in the R375group and R50 group were significantly reduced,and the patients’satisfaction with postoperative analgesia was significantly increased(P<0.05).Compared with the R25 group,the extubation time,the time to exit the PACU,the first exhaust time,and the first time to get out of bed were significantly reduced in the R375 and R50 groups(P<0.05).There was no significant difference in the incidence of adverse reactions such as nausea and vomiting,skin itching,dizziness,drowsiness,and lower limb weakness in the three groups 48 hours after surgery(P>0.05).There were no block-related complications such as puncture site infection,hematoma,and local anesthetic poisoning in the three groups.Conclusion:0.375%and 0.50%ropivacaine for ultrasonic-guided anterior quadratus lumborum block can provide safe and effective analgesia during the perioperative period of percutaneous nephrolithotomy,improve patients’satisfaction with postoperative analgesia,and facilitate early postoperative recovery,and the effect is better than that of 0.25%ropivacaine.Compared with0.50%ropivacaine,the lower concentration of 0.375%ropivacaine has less total amount,lower concentration and higher safety,which is worthy of clinical promotion.