Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (4): 289-296.doi: 10.24920/003759

• 论著 •    下一篇



  1. 1麻醉科,北京协和医院,中国医学科学院 北京协和医学院,北京100730,中国
    2中心实验室,北京协和医院,中国医学科学院 北京协和医学院,北京100730,中国
    3泌尿外科,北京协和医院,中国医学科学院 北京协和医学院,北京100730,中国
  • 收稿日期:2020-04-20 接受日期:2020-06-29 出版日期:2020-12-31 发布日期:2020-10-18
  • 通讯作者: 黄宇光

Ultrasound-Guided Transmuscular Quadratus Lumbar Block Reduces Opioid Consumption after Laparoscopic Partial Nephrectomy

Xulei Cui1,Xu Li1,Minna Li1,Yuelun Zhang2,Yi Xie3,Weigang Yan3,Yushi Zhang3,Zhigang Ji3,Yuguang Huang1,*()   

  1. 1Anesthesiology Department, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2Central Research Laboratory, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    3Urology Department, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2020-04-20 Accepted:2020-06-29 Published:2020-12-31 Online:2020-10-18
  • Contact: Yuguang Huang


目的 经腰方肌阻滞(transmuscular quadratus lumborum block, TQLB)可为腹膜内手术患者提供术后镇痛。本研究目的是检验TQLB在进行腹膜后手术如肾部分切除术(laparoscopic partial nephrectomy, LPN)的患者中的潜在疗效。
方法 本前瞻性随机对照研究于2017年8月至2018年11月在北京协和医院进行。选择18-70岁、ASA身体状况评分为I-II并准备进行LPN的患者为研究对象,随机分为TQLB组(给予0.6mL/kg 0.5%罗哌卡因加全麻)或对照组(单纯全麻)。术后立即开始吗啡静脉自控镇痛。主要结局指标为术后8小时内吗啡的累积消耗量,次要结局指标包括术后其他时间点吗啡的消耗量、休息时和活动期间的疼痛评分、术后恶心呕吐(postoperative nausea and vomitting, PONV)发生率,以及其他与患者恢复相关的指标。
结果 TQLB组和对照组分别招募到30例患者。TQLB组术后8小时吗啡累积消耗量显著低于对照组(中位数,0.023 mg/kg vs. 0.068 mg/kg,U=207.5,P<0.001)。两组术后疼痛评分无显著性差异。TQLB组术后24小时PONV发生率低于对照组(20% vs. 47%,χ2=4.8,P=0.028),术后120小时平均康复质量评分高于对照组(138.6 vs. 131.9,t=-2.164,P=0.035)。
结论 TQLB可在LPN术后早期起到减少阿片类药物用量的作用,同时降低PONV的发生率,提高患者的康复质量。

关键词: 腰方肌阻滞, 阿片类药物, 术后镇痛, 肾部分切除术


Objectives Transmuscular quadratus lumborum block (TQLB) may provide postoperative analgesia in patients undergoing intraperitoneal surgeries. The purpose of this study was to examine the potential efficacy of TQLB among patients undergoing retroperitoneal procedures, such as the laparoscopic partial nephrectomy (LPN).
Methods This prospective, randomized, controlled study was conducted from August 2017 to November 2018 at Peking Union Medical College Hospital (Beijing, China). Patients who were scheduled for a LPN, aged 18-70 years old with an ASA physical status score of I - II were randomly assigned to receive either TQLB with 0.6 ml/kg of 0.5% ropivacaine plus general anesthesia (TQLB group) or general anesthesia alone (control group). Patient-controlled intravenous analgesia with morphine was initiated immediately upon surgery completion. The primary outcome was the cumulative consumption of morphine within 8 h after surgery. The secondary outcome included postoperative consumptions of morphine at other time points, pain score at rest and during activity, postoperative nausea and vomitting (PONV), and recovery related parameters.
Results Totally 30 patients per group were recruited in the study. The 8 h consumption of morphine was lower in the TQLB group than in the control group (median, 0.023 mg/kg vs. 0.068 mg/kg, U=207.5, P<0.001). No significant differences were observed in postoperative pain scores between the two groups. Patients in the TQLB group had fewer episodes of PONV (20% vs. 47%, χ2=4.8, P=0.028) in the first 24 h after surgery and higher scores for quality of recovery (mean, 138.6 vs. 131.9, t=-2.164, P=0.035) 120 h after surgery than the controls.
Conclusions TQLB resulted in an opioid-sparing effect during the early postoperative period following LPN, as well as a lower incidence of PONV and improved quality of recovery.

Key words: quadratus lumbar block, opioids, postoperative analgesia, partial nephrectomy

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