Application Of Ultrasound-guided Quadratus Lumborum Plane Block In Colon Cancer Surgery In Elderly Patient

Objective:Objective To investigate the analgesic and anesthetic effects of general anesthesia combined ultrasound-guided anterior quadratus lumborum block approach at the lateral supra-arcuate ligament in laparoscopic radical operation of colon cancer in elderly patients.Methods:Ninety-two elderly patients（ASA Grade II to III,age 65 to 80 years old）who underwent radical surgery of colon cancer were randomly divided into anterior quadratus lumborum block approach at the lateral supra-arcuate ligament combined with general anesthesia group（SA group）,subcostal approach to anterior quadratus lumborum block combined with general anesthesia group（SC group）and simple general anesthesia group（GA group）.The nerve block in SA group and SC group was performed on both sides,and 0.4%ropivacaine 0.3ml/kg was given to each side.The sensory block plane,mean arterial pressure（MAP）and heart rate（HR）were recorded 5min and 15min after the block,and then general anesthesia was performed after the block took effect,while the nerve block was not performed in GA group.MAP and HR of patients in the three groups were recorded at the time of entering the operating room（T₀）,5min before skin incision（T₁）,at the time of skin incision（T₂）,30min after operation（T₃）,at the end of operation（T₄）,and at the time of postoperative resuscitation extubation（T₅）.Visual analogue scal（VAS）were recorded at T₅,when leaving the postanesthesia care unit and returning to the ward（T₆）,6 hours after the operation（T₇）,12 hours after the operation（T₈）,24 hours after the operation（T₉）,and 48 hours after the operation(T₁₀).The intraoperative use dosage of sufentanil,remifentanil,propofol and vasoactive drugs were recorded.Time to anesthesiologist resuscitation,total number of patient controlled analgesia within 48 hours after surgery,Lovett muscle strength score and early postoperative recovery were recorded.Results:1.MAP and HR in SA group were lower than those in SC group at T_1-5,SC group were lower than GA group（P<0.05）.2.Before and after nerve block,there were no significant differences in MAP and HR between SA group and SC group,and no significant differences in intra-group comparison（P>0.05）.The skin sensory block ranges in the SA group was T₄～L₂,the SC group was T₆～L₂.3.VAS score of SA group was lower than that of LYX and GA groups at T_5-10,SC group was lower than GA group at T_5-9（P<0.05）,but there was no significant difference in VAS score between LYX and GA groups at T₁₀（P>0.05）.4.The intraoperative use dosage of propofol and remifentanil in SA group was lower than that in SC group,SC group was lower than GA group（P<0.05）.The intraoperative dosage of sufentanil in GS and SC groups was lower than that in GA group,but there was no significant difference between GS and SC group（P>0.05）.The amount of ephedrine in SA and SC groups was higher than that in GA group（P<0.05）,while that in SA group was higher than that in SC group（P<0.05）.There was no significant difference in the intraoperative dosage of anisodamine and landiolol among three groups（P>0.05）.5.The anesthesia resuscitation time,the total number of analgesic pump presses and the first time to get out of bed after surgery in the SA group were lower than those in the SC group,SC group were lower than GA group（P<0.05）.The rate of remedial analgesia and the incidence of nausea and vomiting in the GS and SC groups were lower than those in the GA group,but there were no significant differences between the GS and SC groups（P>0.05）.There were no significant differences in Lovett muscle strength score,postoperative length of stay and incidence of dizziness among the three groups（P>0.05）.Conclusions:1.The application of general anesthesia combined with ultrasound-guided quadratus lumborum block in laparoscopic colon cancer surgery in elderly patients is significantly better than general anesthesia alone,which can significantly reduce the dose of general anesthesia and postoperative pain score,and accelerate the recovery of patients;2.General anesthesia combined with ultrasound-guided anterior quadratus lumborum block approach at the lateral supra-arcuate ligament is superior to subcostal approach to anterior quadratus lumborum block in the application of laparoscopic colon cancer surgery in elderly patients,the former can:（1）obtain a more extensive and stable block plane;（2）It is more effective in reducing postoperative pain score,and has more advantages in reducing the dose of general anesthesia and analgesic drugs;（3）The fluctuation range of intraoperative circulation was smaller and the circulation was more stable;（4）Shorten the time for patients to get out of bed for the first time after surgery,reduce postoperative complications,and promote early recovery of patients.