| Objective: To study the effect of anterior quadratus lumborum block(QLB)at L2 level on perioperative analgesia and postoperative recovery quality in patients following laparoscopic partial nephrectomy under general anesthesia.Methods: 63 patients aged from 18 to 70 years old,with ASA physical status Ⅰ-II,who diagnosed with renal tumor and scheduled for laparoscopic partial nephrectomy were allocated randomly into one of two groups(n= 31 for group C,n=32 for group Q).The QLB group received an anterior QLB at L2 level prior to general anesthesia with 0.5% ropivacaine 25-30 m L at the operative side,and the pain block plane was measured after 30-40min;the control group did not received regional block.Standard monitoring,bispectral index(BIS)monitoring and invasive blood pressure were performed in the operating theatre.All patients were induced with midazolum 2-3mg,propofol 1-1.5mg/kg,sufentanil 0.5μg/kg and cisatracurium 0.15mg/kg.After tracheal intubation,anesthesia was maintained with propofol 3-4mg/kg/h,remifentanil0.15μg/kg/min and cisatracurium 0.1mg/kg/h.Medications were adjusted according to BIS values,surgical pleth index(SPI)and hemodynamics changes.The intraoperative blood pressure was maintained within ± 20% of base value of blood pressure,the target range of end-tidal carbon dioxide concentration was 35-45 mm Hg,the target range of BIS was 40-60,the target range of SPI was 20-50 during maintenance.Flurbiprofen axetil 50 mg and tropisetron 5mg were injected in all patients 30 minutes before the end of the operation.All patients received patient controlled intravenous analgesia(PCIA)pump after operation.PCIA pump contained sufentanil 200μg,tropisetron 10 mg and normal saline in a total volume of 100 m L,and was set to deliver a bolus dose of 2m L with 15 min lockout interval with no background.The total consumption of sufentanil during the perioperative period,changes in blood pressure and heart rate before and after skin incision,the total amount of remifentanil,propofol and sufentanil used during the operation,the amount of sufentanil after operation,resting and dynamic numerical rating scale(NRS)scores,the incidence of postoperative nausea and vomiting(PONV),the incidence of postoperative rescue analgesia,the time from postoperation to discharge,anesthesia satisfaction and postoperative recovery quality were recorded.Result:A total of 59 patients were included in this study(n= 29 for group C,n=30 for group Q).Patient demographics for the two groups were comparable.The total consumption of sufentanil during the perioperative period and the amount of sufentanil at 0-6h,6-12 h and 12-24 h after the operation in group Q was significantly lower than those in group C(P<0.05).However,there was no significant difference in the dosage of sufentanil at 24-48 h after surgery in group Q and group C(P>0.05).Group Q achieved a sensory blockade of somatic pain on the T9-L1 before anesthesia induction.The difference in blood pressure and heart rate before and after skin incision in group C was statistically significant(P<0.05).There was no significant difference in blood pressure and heart rate before and after skin incision in group Q(P>0.05).NRS scores at rest and cough at each postoperative time point and the incidence of postoperative rescue analgesia in group Q were significantly lower than those in group C(P<0.05).The two groups of patients’ intraoperative propofol and remifentanil dosage,the incidence of PONV,the time from postoperation to discharge,postoperative recovery quality and anesthesia satisfaction were not significant different(P>0.05).Conclusion: Anterior QLB at L2 level combined with general anesthesia significantly reduced the total perioperative consumption of sufentanil and alleviated postoperative pain in patients undergoing laparoscopic partial nephrectomy,but it could not improve postoperative recovery quality and anesthesia satisfaction. |
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