The Postoperative Analgesia Of Ropivacaine Combined With Dexamethasone Use For Quadratus Lumborum Block In Patients Underwent Laparoscopic Nephrectomy

Objective: We aimed to evaluate the postoperative analgesic effect of ropivacaine combined with dexamethasone use for subcostal quadratus lumborum block in patients underwent laparoscopic nephrectomy.Methods: We prospectively included 82 patients（aged 18-75 years,BMI < 30kg/m2,and ASA physical status I-III）who underwent laparoscopic nephrectomy under general anesthesia.All patients were randomly assigned into two groups: the ropivacaine group（L group,n=41）received 0.375% ropivacaine 20 ml,and the ropivacaine combined with dexamethasone group（LD group,n=41）received 0.375%ropivacaine 20 ml and dexamethasone 5 mg use for unilateral subcostal quadratus lumborum block under ultrasound-guided before anesthesia induction.The protocols of anesthesia induction and maintenance were comparable in two groups.We recorded the visual analogue scale（VAS）immediately after tracheal extubation（T0）and follow by 30 min（T1）,2h（T2）,8h（T3）,16h（T4）,24h（T5）,36（T6）,48h（T7）,and the first time of patient controlled analgesia（PCA）.We also recorded the intraoperative mean arterial pressure（MAP）,heart rate（HR）,and oxygen saturation in time of interval 15 min.The times of postoperatively feeding,exhaust,and exercise,the complications related block（hematoma,myasthenia,infection,and toxic reaction）,the rate of postoperative nausea and vomiting,and the length of hospital stay were also be evaluated in both groups.Results: The patients in LD-group had longer time to use the PCA in first time,and lower VAS in every postoperative exercise within 24 h,and lower VAS in postoperative rest within 16 h,than those in L-group（P < 0.01,P < 0.05,and P <0.05,respectively）;while the VAS in rest in postoperative 36 h and later was not showed significant difference in both groups（P > 0.05）.Moreover,the length of hospital stay in LD-group was shorter than L-group（P < 0.05）.Other variables,such as hemodynamic parameter,postoperative nausea and vomiting,postoperative opioids consumption,the times of feeding and exhaust,the time of exercise postoperatively were not showed significant difference in both groups（P < 0.05）.One case experienced postoperative myasthenia in L-group.Conclusion: Our results release that the ropivacaine combined with dexamethasone use for unilateral subcostal quadratus lumborum block showed superiority over the ropivacaine group in terms of postoperative opioids consumption,the VAS in postoperative 24 h,and the length of hospital stay.