Quadratus Lumborum Block Combined With Butorphanol PCIA Observation Of Analgesic Effect After Cesarean Section

Objective:The purpose of this study was to investigate the effect of ultrasound-guided Quadratus Lumborum Block（QLB）combined with patient-controlled intravenous analgesia（PCIA）on analgesia in patients after cesarean section.Methods:From January 2022 to February 2023,112 parturients,aged 2044 years,ASA grade II,who underwent cesarean section in Ganzhou Maternal and Child Health Hospital were selected.Approved by the Ethics Committee of Ganzhou Maternal and Child Health Hospital,patients who underwent cesarean section under combined spinal-epidural anesthesia after obtaining written informed consent.The patients were randomly divided into two groups by random number table method,with 56 cases in each group.Different analgesic schemes were used respectively.Group Q:quadratus lumborum block+butorphanol injection 10 mg+tropisetron injection 10 mg;group T:transversus abdominis plane block+butorphanol injection 10 mg+tropisetron injection 10 mg.The VAS pain scores at rest and during exercise were recorded at 2h（T₁）,6h（T₂）,12h（T₃）and 24h（T₄）after operation.The total number of analgesic pump compressions,the number of remedial analgesia cases,adverse reactions,the incidence of lower limb motor block,Ramsay sedation score,and maternal analgesia satisfaction 24 hours after surgery.Results:1.Comparison of general conditions:There was no significant difference in age,BMI and operation time between the two groups（P>0.05）.2.Comparison of VAS pain scores between the two groups at 2h（T₁）,6h（T₂）,12h（T₃）and 24h（T₄）after operation:There was no significant difference in VAS pain scores between the two groups at 2h（T₁）after operation（P>0.05）.The VAS scores of group Q were lower than those of group T at 6h（T₂）,12h（T₃）and 24h（T₄）after operation（P<0.05）.There was no significant difference in VAS pain score between the two groups at 2h（T₁）（P>0.05）.The VAS score of group Q was lower than that of group T at 6h（T₂）,12h（T₃）and24h（T₄）after operation（P<0.05）.3.Comparison of PCIA effective pressing times within 24 hours after operation between the two groups:The total number of PCIApressing times within 24 hours was（5.84±1.42）in group Q and（9.68±1.43）in group T.The number of PCIApressing times in group Q was less than that in group T,and the difference between the two groups was statistically significant（P<0.05）.4.Comparison of the number of remedial analgesia cases within 24 hours after operation between the two groups:Q group 1（1.8%）,T group 4（7.1%）,the number of remedial analgesia cases in Q group was less than that in T group,the difference was not statistically significant（P>0.05）.5.Comparison of the incidence of analgesia-related adverse reactions within 24 hours after operation between the two groups:24-hour adverse reactions were 3（5.36%）in group Q and 10（17.86%）in group T.The incidence of adverse reactions within 24 hours after operation in group Q was lower than that in group T,and the difference was statistically significant（P<0.05）.6.Comparison of Bruggrmann comfort scale（BCS）between the two groups:Q group3.00（2.00,3.00）,T group 2.00（2.00,2.00）,Q group BCS score was higher than T group,the difference was statistically significant（P<0.05）.7.Comparison of maternal analgesia satisfaction between the two groups:satisfactory and very satisfactory patients in group Q 53（95%）,group T 44（79%）;the degree of analgesia in group Q was higher than that in group T,and the difference between the two groups was statistically significant（P<0.05）.8.Comparison of butorphanol usage within 24 hours after operation between the two groups:group Q（5.97±0.29）,group T（6.74±0.29）,butorphanol usage within 24 hours after operation in group Q was less than that in group T,and the difference between the two groups was statistically significant（P<0.05）.9.There was no significant difference in lower limb motor nerve block score and Ramsay sedation score between the two groups（P>0.05）.Conclusion:Quadratus lumborum block combined with butorphanol PCIA analgesia is safe and effective in postoperative analgesia after cesarean section.Compared with transversus abdominis plane block combined with PCIA analgesia,quadratus lumborum block combined with butorphanol PCIA can effectively reduce postoperative pain score,reduce the incidence of adverse reactions,improve maternal comfort and analgesia satisfaction.Quadratus lumborum block combined with butorphanol PCIA is recommended as a component of multimodal analgesia.