Effects Of Quadratus Psoas Block On POD And Postoperative Analgesia In Elderly Patients Undergoing Abdominal Surgery

Objective: To investigate the effect of ultrasound guided bilateral quadratus lumbosum muscle block(QLB)on POD and postoperative analgesia in elderly patients undergoing abdominal surgery.Methods: 60 elderly patients with ASA grade Ⅰ-Ⅱ and ages ranging from 65 to 85 years old were selected for elective abdominal surgery.They were randomly assigned by computer to the quadratus psoas muscle block combined with general anesthesia group(Group-Q)and general anesthesia group(Group-A),with 30 patients in each group.Two groups of patients were preoperatively assessed by the simple mental state checklist(MMSE),the Chinese revised version of the fuzzy assessment scale(CAM-CR)and the daily living activities(ADLs),respectively,to assess the status of basic cognitive function,the presence of delirium and the ability of daily living activities.In group Q,after entering the operating room and before induction of general anesthesia,bilateral quadrat lumbar muscle block was conducted under ultrasound guidance,and 0.375% ropivacaine was injected 20 ml on each side.Group A did not undergo quadrat psoas block before induction of general anesthesia.Patients in both groups received intravenous patient-controlled analgesia(PCIA)of the same drug concentration after surgery.Preoperative blood glucose level,preoperative(T0),5 minutes after admission(T1),endotracheal intubation(T2),skin peeling(T3),30 minutes after surgery(T4),at the end of surgery(T5),and at the time when the patient was removed from PACU(T6)were recorded.The dosage of sufentanil,propofol,remifentanil,atracurium iso-benzene sulfonate and other drugs accumulated during the operation;Duration of operation,type and amount of intraoperative fluid supplement,intraoperative blood loss and urine volume;The time from the end of operation to tracheal catheter extraction;Stay in the recovery room;Restlessness,delayed resuscitation and respiratory depression during resuscitation;Intraoperative knowledge of whether it has occurred.Record the number of effective PCIA press in patients within 24 hours after surgery;The time,frequency,type and total amount of remedial analgesia;Blood glucose level 1,3,5 and 7 days after the operation;The patients were followed up and recorded their first time of getting out of bed,the first time of intestinal exhaust,the first time of defecation,the occurrence of postoperative PONV,postoperative intestinal obstruction,anastomotic fistula,etc.Patients were followed up 1-7 days after surgery by the cam-cr scale and POD was recorded.Patients were followed up and recorded 1-7 days after the operation,including ADLs,visualanalog score(VAS),digital pain grading(NRS),comfort score(BCS),and satisfaction with the analgesic effect 1-5 days after the operation.CRP values were recorded at day 1,3,and 7.Results:Compared with Group-A,POD incidence in Group-Q was reduced within 7 days after surgery(P < 0.01).Intraoperative use of propofol and remifentanil decreased(P < 0.01).Extubation time was shorter(P < 0.01);The length of stay in hospital was shorter(P < 0.01),the time of first getting out of bed,intestinal exhaust and intestinal defecation were shorter(P < 0.01).The number of postoperative analgesic pump compressions was less at 24h(P < 0.01).Morphine dosage decreased(P<0.05).VAS score was lower 1-5 days after surgery(P < 0.01)and NRS score was lower 1-6 days after surgery(P <0.01).The BCS of 1-6 days after surgery were higher(P < 0.01).Postoperative analgesia satisfaction was higher(P < 0.01).Conclusion:Under the guidance of ultrasound,QLB can reduce the occurrence of POD in elderly patients undergoing abdominal surgery,enhance postoperative analgesic effect,accelerate the recovery of gastrointestinal function,and increase patient satisfaction.