A Comparative Study Of Ultrasound-guided Modified Lower Serratus Anterior Plane Block And Quadratus Lumbosum Block In Postoperative Analgesia After Laparoscopic Nephrectomy

Objective:To investigate the effects of ultrasound-guided modified lower serratus anterior plane block(SAPB)and ultrasound-guided quadratus lumborum block(QLB)on postoperative analgesia and early postoperative recovery quality of patients undergoing laparoscopic nephrectomy.method:Fifty patients,aged 18 to 65 years old,with ASA grade I to II,were selected for elective laparoscopic nephrectomy in our hospital.They were divided into two groups(n=25)by simple random method: the ultrasound guided modified low group SAPB(Group S)and the anterior group QLB(Group Q).Before the operation,patients in each group were subjected to low SAPB and anterior QLB with ultrasound machine.30 min after the operation,the skin temperature block area was tested with ice cubes every 10 minutes.All patients underwent rapid induction of general anesthesia after entering the room,and patient-controlled intravenous analgesia(PCIA)was used in both groups after operation.The operation time,effective time of nerve block and skin sensory block level of patients in the two groups were recorded.The two groups were compared 1h、2h、4h、6h、12h 、24h and 48 h after surgery.Visual analog pain scale(VAS),postoperative quality of recovery(QOR-15),times of postoperative analgesic pump pressing and total amount of analgesic drugs,occurrence of postoperative nausea,vomiting,hematoma and other adverse reactions at each time point 48 h after surgery.result:Compared with group Q,the operation time and effective time of ultrasound-guided block were shorter in group S(P<0.05).VAS scores at 1h、 2h、 h、4h、6h、12h、24h、48h after surgery showed no statistical significance between 2 groups(P>0.05).The QOR-15 score of the S group was higher than that of the group Q24 h after surgery(P < 0.05).There was no statistical significance in the intraoperative consumption of propofol and remifentanil between the two groups(P>0.05),and no statistical significance in The Times of analgesic pump pressing between the group S and the group Q(P > 0.05).There was no statistical significance in the incidence of adverse reactions between 2 groups(P>0.05).The plane range of sensory block in group S was concentrated in T7-T11,with the broadest head up to T5 level and the caudal up to T12 level.The plane range in group Q was mainly concentrated in T9-L1,with the broadest head up to T7 level and the caudal up to L2 level.conclusion:Ultrasound guided improvement of low SAPB and anterior QLB can effectively alleviate and improve postoperative pain in patients with laparoscopic nephrectomy and reduce the use of sedative and analgesic drugs.Compared with QLB,modified low SAPB is easier to operate,more effective and safer,and can improve the quality of early postoperative recovery and accelerate the recovery of patients.