| Objective:To compare the clinical results of different volumes of 0.25%ropivacaine performing ultrasound-guided subcostal approach to anterior quadratus lumborum block for laparoscopic cholecystectomy and to provide a reference for selecting the appropriate volume for this approach.Methods:Ninety-nine patients,aged 23-69 years,ASA class Ⅰ-Ⅱ,who underwent elective laparoscopic cholecystectomy in our hospital from March 2022 to March 2023 were selected.The patients were randomly divided into three groups using the random number table method:group QA(0.25%pivacaine 25 ml/side,n=33),group QB(0.25%ropivacaine 30 ml/side,n=33)and group QC(0.25%ropivacaine 35 ml/side,n=33),and all patients underwent preoperative ultrasound-guided subcostal approach to anterior quadratus lumborum block.The extent of skin sensory block at 5,10 and 15 min after block completion,numeric rating scale(NRS)at different time points during the postoperative 48 h,the intraoperative analgesic drug dosage,the quality of recovery-15 scale(QoR-15)of fifteen items at 24 h after surgery,the time and dosage of the first postoperative remedial analgesia and the occurrence of perioperative adverse effects or complications were recorded in the three groups.Results:1.Compared with the QA group,the range of skin sensory block was significantly increased in the QB and QC groups 15 min after block completion,and the difference was statistically significant(P<0.05);there was no significant difference in the range of skin sensory block between the QB and QC groups(P>0.05).2.Compared with the QA group,the NRS at 3h,6h,and 12h postoperatively were significantly decreased in the QB and QC groups,and the difference was statistically significant(P<0.05);there was no significant difference in NRS at each postoperative time point between the QB and QC groups(P>0.05);there was no significant difference in NRS at 0h,24h and 48h postoperatively between the three groups(P>0.05).3.Compared with the QA group,the 24h postoperative QoR-15 was significantly higher in the QB and QC groups,and the difference was statistically significant(P<0.05);there was no significant difference in the 24h postoperative QoR-15 between the QB and QC groups(P>0.05).4.Compared with the QA group,there was a statistically significant difference between the QB and QC groups in the dosage of intraoperative analgesic drugs(P<0.05);there was no significant difference in the dosage of intraoperative analgesic drugs between the QB and QC groups(P>0.05).5.Compared with the QA group,there was a statistically significant difference between the QB and QC groups in the dosage of intraoperative analgesic drugs,QC group had significantly longer time of first postoperative remedial analgesia and significantly higher amount of remedial analgesic drugs,and the difference was statistically significant(P<0.05);there was no significant difference in the time of first postoperative remedial analgesia and amount of remedial analgesic drugs between QB and QC groups(P>0.05).6.There was no significant difference in the incidence of postoperative nausea and vomiting between QA,QB and QC groups(P>0.05).Conclusion:In this study,by comparing three clinically used volumes of 0.25%ropivacaine,we tentatively concluded that 30 ml and 35 ml per side injection of subcostal approach to anterior quadratus lumborum block under ultrasound guidance for laparoscopic cholecystectomy could both effectively improve postoperative pain,reduce analgesic drug dosage,and be more beneficial to patients’ early postoperative recovery.Therefore,we recommend 30 ml of injection per side as the optimal volume of quadratus lumborum block for this approach. |
