BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress respon...BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.展开更多
Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-...Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.展开更多
<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and s...<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. <b>Methods:</b> The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. <b>Results:</b> Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. <b>Limitation:</b> Small sample size and shorter period for postoperative follow-up. <b>Conclusions:</b> Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.展开更多
In recent years, domestic laparoscopic surgery has gradually matured. Most pelvic and intra-abdominal lesions will be treated with minimally invasive laparoscopic surgery. Compared with traditional open surgery, lapar...In recent years, domestic laparoscopic surgery has gradually matured. Most pelvic and intra-abdominal lesions will be treated with minimally invasive laparoscopic surgery. Compared with traditional open surgery, laparoscopic surgery has the advantages of small wound, small pulling range, less complications and quick recovery after operation. Therefore, quadratus lumborumblock nerve block (QLB) has become an indispensable part in multimodal analgesia, which can reduce postoperative pain, significantly reduce the amount of postoperative opioid use and the occurrence of adverse reactions, and enable patients to get out of bed early.展开更多
目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状...目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状韧带上腰方肌阻滞联合全麻,E组超声引导下竖脊肌阻滞联合全麻,N组单纯全麻。3组患者术后均采用静脉自控镇痛泵(PCIA)。记录3组患者苏醒时、术后6、12、24 h的Richmond躁动-镇静(RASS)评分和伯格曼舒适度量表(BCS)评分;记录PCA使用结束Likert量表评分;记录术前1 d和术后1、3 d的匹兹堡睡眠质量指数(PSQI)及术后早期康复质量指标(QoR-15);记录术后苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间、首次下床时间、术后住院时间及术后48 h内不良反应发生情况。结果(1)与N组比较,Q组术后各时点RASS评分较低且BCS评分较高,PCA使用结束后Likert评分1级比例更高(P<0.05);E组苏醒时、术后24 h RASS评分较N组低,苏醒时、术后6、24 h BCS评分较N组高(P<0.05);与E组比较,Q组术后12 h RASS评分较低且BCS评分较高(P<0.05)。(2)Q组与N组比较,术后1、3 d PSQI评分较低且QoR-15评分较高(P<0.05);而E组与N组比较,PSQI评分差异无统计学意义(P>0.05),E组仅在术后1 d QoR-15评分较N组高(P<0.05)。(3)与N组比较,Q组苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间及首次下床时间均显著缩短(P<0.05);E组仅首次肛门排气时间短于N组(P<0.05);Q组出复苏室时间较E组缩短(P<0.01)。(4)三组患者不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下弓状韧带上腰方肌阻滞和竖脊肌阻滞均能有效改善术后镇痛效果与早期康复质量,但弓状韧带上腰方肌阻滞在提升患者舒适度和镇痛满意度、促进睡眠质量及加速术后整体恢复方面更具优势。展开更多
文摘BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.
基金supported by Young Scholar Research Grant of Chinese Anesthesiologist Association(No.21800009).
文摘Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.
文摘<b>Background:</b> Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. <b>Aim:</b> To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. <b>Methods:</b> The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. <b>Results:</b> Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.) (P < 0.001) respectively, mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in Group I (5.17 ± 1.32 mg) than in Group II (7.33 ± 1.45 mg) (P < 0.001). A larger number of patients in Group II had nausea at different time points postoperatively than in Group I (P < 0.001), but no significant difference was observed between both studied groups regarding the incidence of vomiting. <b>Limitation:</b> Small sample size and shorter period for postoperative follow-up. <b>Conclusions:</b> Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.
文摘In recent years, domestic laparoscopic surgery has gradually matured. Most pelvic and intra-abdominal lesions will be treated with minimally invasive laparoscopic surgery. Compared with traditional open surgery, laparoscopic surgery has the advantages of small wound, small pulling range, less complications and quick recovery after operation. Therefore, quadratus lumborumblock nerve block (QLB) has become an indispensable part in multimodal analgesia, which can reduce postoperative pain, significantly reduce the amount of postoperative opioid use and the occurrence of adverse reactions, and enable patients to get out of bed early.
文摘目的探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。方法选择择期行后路腰椎手术患者93例,性别不限,年龄25~70岁,体质量指数(BMI)18~30 kg/m2,ASA分级Ⅱ~Ⅲ级,随机分为3组。Q组超声引导下弓状韧带上腰方肌阻滞联合全麻,E组超声引导下竖脊肌阻滞联合全麻,N组单纯全麻。3组患者术后均采用静脉自控镇痛泵(PCIA)。记录3组患者苏醒时、术后6、12、24 h的Richmond躁动-镇静(RASS)评分和伯格曼舒适度量表(BCS)评分;记录PCA使用结束Likert量表评分;记录术前1 d和术后1、3 d的匹兹堡睡眠质量指数(PSQI)及术后早期康复质量指标(QoR-15);记录术后苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间、首次下床时间、术后住院时间及术后48 h内不良反应发生情况。结果(1)与N组比较,Q组术后各时点RASS评分较低且BCS评分较高,PCA使用结束后Likert评分1级比例更高(P<0.05);E组苏醒时、术后24 h RASS评分较N组低,苏醒时、术后6、24 h BCS评分较N组高(P<0.05);与E组比较,Q组术后12 h RASS评分较低且BCS评分较高(P<0.05)。(2)Q组与N组比较,术后1、3 d PSQI评分较低且QoR-15评分较高(P<0.05);而E组与N组比较,PSQI评分差异无统计学意义(P>0.05),E组仅在术后1 d QoR-15评分较N组高(P<0.05)。(3)与N组比较,Q组苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间及首次下床时间均显著缩短(P<0.05);E组仅首次肛门排气时间短于N组(P<0.05);Q组出复苏室时间较E组缩短(P<0.01)。(4)三组患者不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下弓状韧带上腰方肌阻滞和竖脊肌阻滞均能有效改善术后镇痛效果与早期康复质量,但弓状韧带上腰方肌阻滞在提升患者舒适度和镇痛满意度、促进睡眠质量及加速术后整体恢复方面更具优势。
