Effect Of Ultrasound-guided Quadratus Lumborum Block On Patients Undergoing Radical Resection Of Colorectal Cancer

ObjectiveTo explore an optimal anesthesia method for laparoscopic colorectal cancer radical surgery,by comparison of ultrasound-guided quadratus lumborum block and transverse abdominis plane block on the analgesic effect,coagulation function and cellular immunity in patients.Methods1.Forty-five American Society of Anesthesiologists physical status I or II patients of both sexes,aged 18-80 yrs,with body mass index of 20-25kg/m² with laparoscopic radical resection of colorectal cancer were selected.2.Groups:The patients was divided into 3 groups by random number table method.n=15):Q group（quadratus lumborum block combined with general anesthesia group）,T group（transverse abdominis plane block combined with general anesthesia group）and G group（general anesthesia group）,15 cases in each group.3.Methods:Patients in Q group received ultrasound-guided bilateral quadratus lumborum blocks and Patients in T group received ultrasound-guided bilateral transverse abdominis plane blocks which were performed before induction of general anesthesia 30 minutes.All patients underwent conventional induction and anesthesia maintenance with TCI propofol and remifentanil,maintaining BIS value of 42-52.All patients were given PCIA（patient-controlled intravenous analgesia）after surgery,maintaining VAS≤3 points.4.Observatory parameters:Observe and record the BP,HR,SpO₂,BIS value,transfusion volume,bleeding volume,urine volume,operation time and the consumption of remifentanil and propofol during operation.Before induction,record the blockage range and effect of Q and T groups;Ricker sedation and agitation scores,BP,HR,respiratory depression as well as other adverse events were recorded at 5min,10min,30 min after tracheal extubation and 12h,24h,and 48 h after surgery.At the time of before the induction of anesthesia,at the end of surgery,24h and 48 hours after surgery,the central venous blood samples of the Q and G groups were collected to determine the thromboelastogram and the levels of CD3+,CD4+,CD8+and CD4+/CD8+in the T lymphocyte subsets.Results1.There was no significant difference in general data among the groups（P>0.05）.2.Comparison of sensory block:Compared with the T group,the number of cases in Q group at the T7 and T8 was significantly more than that in T group（P<0.05）,and the other block planes were not statistically significant（P>0.05）.Compared with T group,the number of cases about the abdominal sensory block was significantly higher than that in the T group at 24h and 36h after operation（P<0.05）.There was no significant difference between the other time points（P>0.05）.3.Comparion of perioperative index:MAP and HR were significantly increased in the Q,T and G groups at the T₂ time point compared at T₁（P<0.05）.Compared with the Q group,the MAP increased significantly in the G group at the T₃ and T₄ time points,（P<0.05）.There was no significant difference in the changes of MAP and HR between the Q and T groups（P>0.05）.4.Compared with group G,the consumption of propofol in the Q group and the T group was decreased（P<0.05）,the consumption of remifentanil in the Q group was decreased（P<0.05）,and the number of PCIA compressions in the Q group and the T group was significantly decreased at T₁₀（P<0.05）.The number of PCIA compressions in the Q group was significantly decreased at T_11.5.Compared with G group,there were no significant differences in the parameters of R,K,αand MA between the preoperative group,the operation,and the24 and 48 hours after operation（P>0.05）.6.Compared with G group,the level of CD3+was higher at 24 and 48h after operation in Q group（P<0.05）,and the level of CD8+was lower at 24h and 48h after operation in Q group（P<0.05）.The CD4+/CD8+was higherat 48 hours after operation in Q group（P<0.05）.Compared with preoperative the levels of CD3+,CD4+and the CD4+/CD8+ratio were decreased in the Q and G groups at the end of surgery;The level of CD3+was decreased in the G group at 48h after operation（P<0.05）,and the level of CD8+was decreased in the Q group at 24h and48h after surgery（P<0.05）.7.Compared with G group,SAS scores decreased at 5 min after tracheal extubation in Q and T group（P<0.05）.ConclusionQuadratus lumborum block combined with general anesthesia can reduce the consumption of general anesthetic drugs in patients undergoing radical resection of colorectal cancer,improve postoperative cellular immune function,and have satisfactory perioperative analgesia.It is a suitable anesthesia for radical resection of colorectal cancer.