| Background:As early as 1992,Katharine Kolcaba et al.proposed the theory of"comfort medicine" and believed that "pain control" was the basis of "comfort medicine".Enhanced recovery after surgery(ERAS)is a new concept of perioperative management in recent years.With the support of evidence-based medicine,a series of positive measures,such as multidisciplinary cooperation and optimization of perioperative diagnosis and treatment plan,are adopted to achieve the goal of rapid postoperative recovery.The core of ERAS is to minimize stress.However,for surgical procedures(especially for abdominal procedures,such as radical gastrectomy,radical gastrectomy,and radical gastrectomy),the main cause of stress is perioperative pain,which seriously affects the patient’s postoperative recovery.Therefore,effective perioperative "pain control" is of vital importance for postoperative rehabilitation of patients undergoing abdominal surgery,which is not only conducive to reducing the stress of patients and reducing the incidence of perioperative complications,but also can ultimately speed up the postoperative recovery of such patients.At present,opioids are the main drugs for perioperative pain management,but their application has increased the incidence of adverse reactions(such as nausea and vomiting,respiratory depression,oversedation,constipation,etc.),which is not conducive to the postoperative recovery of patients.Based on the new concept of postoperative rehabilitation endowed by ERAS,how to effectively control pain and reduce stress in perioperative period,so as to reduce the risk of perioperative complications,has become the key to accelerate postoperative rehabilitation.In recent years,with the application of ultrasound-guided visualization technology in the field of anesthesia,perioperative multimodal analgesia,mainly based on regional anesthesia,has played an important role in promoting postoperative rehabilitation of surgical patients.Quadratus lumborum block(QLB)is a relatively new regional nerve block technique,first proposed by Blanco et al.in 2007,which produces analgesic effects by injecting a local anesthetic around the quadratus lumas muscle and spreading the drug along the thoracolumbar fascia.QLB has been proven to provide a wide range of anaesthesia(T10-L4,anterior QLB)and has been successfully used for analgesia in different abdominal procedures at different ages.Compared with general anesthesia alone,QLB under the guidance of general anesthesia combined with ultrasound can effectively reduce perioperative opioid dosage,enhance analgesia effect and improve patient comfort.Up to now,although different doses of ropivacaine have been reported in the literature for QLB,there is still no consensus on the optimal or optimal dose of ropivacaine,let alone the lack of relevant studies on the changes of blood concentration after injection of different doses of ropivacaine.In this study,patients undergoing elective laparoscopic radical resection of colon cancer were selected to observe the effects of QLB with different doses of ropivacaine(2mg/kg,3mg/kg)on perioperative analgesic drug dosage,analgesic effect and short-term prognosis,and LC-MS/MS was used to detect the changes in blood concentration of ropivacaine.To investigate the safety and efficacy of ropivacaine in QLB.Objective:To observe the effects of QLB with different doses(2mg/kg,3mg/kg)of ropivacaine on perioperative analgesic drug dosage,analgesic effect and short-term prognosis of patients undergoing radical laparoscopic colorectal cancer,and to monitor the changes in blood concentration of ropivacaine,so as to preliminarily explore the safety and effectiveness of ropivacaine for QLB.Methods:total of 70 patients(45 males and 25 females,aged 18-79 years,ASA grade Ⅰ～Ⅲ)who underwent laparoscopic radical resection of colon cancer in our hospital on April 1,2019 and December 30,2020 were selected.Using random number table method,they were divided into simple general anesthesia group(GA group,n=10),QLB group with general anesthesia combined with 2mg/kg ropivacaine(QLB-Ⅰ group,n=30)and QLB group with general anesthesia combined with 3mg/kg ropivacaine(QLB-Ⅱ group,n=30).Ga group was given simple general anesthesia,QLB(2mg/kg ropivacaine 40ml)combined with ultrasound guided QLB(2mg/kg ropivacaine 40ml)combined with general anesthesia and QLB(3mg/kg ropivacaine 40ml)combined with ultrasound guided QLB(3mg/kg ropivacaine 40ml)in QLB-Ⅰgroup.Central venous blood was extracted at 15min,30min,45min,1h and 2h after nerve block,and plasma ropivacaine concentration was detected.VAS scores at 1h,3h,6h,12h,24h and 48h after surgery were recorded.The amount of opioids,frequency of remedial analgesia,time of first exhaust,defecation and out of bed,incidence of postoperative nausea and vomiting,and length of hospital stay were recorded during and after operation.Results:The VAS scores of the patients in the QLB-Ⅰ and QLB-Ⅱ groups at 1h,3h,and 6h after the operation were obviously lower than the VAS scores of the GA group(P<0.05);the QLB-Ⅰ group and the QLB-Ⅱ group were significantly lower after the surgery.There was no obvious difference of the VAS scores at each time point(P>0.05).In the QLB-Ⅰ and QLB-Ⅱ groups,the intraoperative opioid dosage,postoperative opioid dosage,remedial analgesia frequency,first exhaust time,first time to get out of bed,and the incidence of nausea and vomiting were lower in both groups GA group(P<0.05);There was no obvious difference of the above indicators between QLB-Ⅰ group and QLB-Ⅱ group(P>0.05).The average peak blood concentration of ropivacaine in the QLB-Ⅰ group and QLB-Ⅱ group appeared 30 minutes after administration,and the QLB-Ⅰ group was 1.45(0.88)μg/ml,which was lower than the threshold concentration for neurotoxicity[2.2(0.9)μg/ml],the difference was statistically significant(P=0.024);QLB-Ⅱ group was 2.62(1.21)μg/ml,higher than[2.2(0.9)μg/ml],the difference was not statistically significant(P=0.254).The average peak blood concentration of ropivacaine in the QLB-Ⅰ group was lower than the average peak blood concentration in the QLB-Ⅱ group,and the difference was very significant(P=0.019).The concentration of ropivacaine in the QLB-Ⅰ group was lower than that in the QLB-Ⅱ group at all detection time points(15min,30min,45min,1h and 2h after injection),and the difference was statistically obvious.(P<0.05).Conclusion:Compared with general anesthesia,general anesthesia combined with ultrasound-guided quadratus lumborum block can effectively reduce postoperative pain,reduce the amount of opioid analgesics,and improve the short-term prognosis of patients.The use of 2mg/kg or 3mg/kg of ropivacaine for ultrasound-guided quadratus lumborum block has similar analgesic effects and prognostic effects.Ropivacaine 2mg/kg is safer and has the lower risk of potential neurotoxicity. |
PDF Full Text Request