| BackgroundPrimary liver cancer is one of the most common malignancies.According to the latest global cancer burden(GLOBOCAN 2012)released by the international agency for research on cancer in 2012,there were about 782.000 new cases of liver cancer in the world and 50.5%of which were in China,746,000 cases of liver cancer died and 51%of which were in China.At present,the treatment methods for liver cancer include surgical treatment,interventional treatment,radiotherapy and chemotherapy.Hepatectomy is one of the most important methods for the treatment of hepatocellular carcinoma.Laparoscopic surgery has the characteristics of less surgical trauma and faster postoperative recovery.With the development of anesthetic drugs and techniques,the anesthesia method of liver resection has developed from the intraspinal anesthesia to the general anesthesia.However,general anesthesia can not suppress the stress response during surgery completely.At the same time,the site of postoperative pain is not only the incision pain in the epidermis,but also the visceral pain in the deep tissue.As a result,pain scores tend to be higher within 48 hours after hepatectomy.With the improvement of anesthesia technology and patients'increasingly higher requirements for comfortable medical treatment,the combined application of various anesthesia methods during the perioperative period has been widely used in clinical practice.Combined application of multiple anesthesia methods can not only give play to the advantages of various anesthesia methods,but also but also reduce the side effects and dosage of anesthesia drugs.improving postoperative pain and recovery of patients.It also plays an important role in improving postoperative pain and recovery.In recent years,with the continuous development of ultrasound-guided nerve block technology,a variety of trunk nerve block methods such as transverse abdominis block,rectus sheath Block and quadratus lumborum block have been proposed and verified in clinical applications.Quadratus lumborum block is a new method of peripheral nerve block,which has been used in cesarean section.gynecological laparoscopic surgery,pyelectomy,etc.Numerous cadaveric studies and clinical studies have shown that quadratus lumborum block provides more lasting and extensive perioperative analgesia than other methods.Operating under ultrasound,the tissue structure around the site to be blocked can be clearly observed,the precise direction of the needle can be guided,and the diffusion direction of the local anesthetic can be observed accurately.ObjectiveTo retrospectively analyze the effect of quadratus lumborum block on postoperative acute pain of patients experienced laparoscopic hepatectomy.Methods24 patients,who experienced selective laparoscopic hepatectomy under total intravenous general anesthesia in our hospital from January to August 2018,were selected according to inclusion and exclusion criteria.Patients who only accept total intravenous general anesthesia were assigned to control group.Patients who accept total intravenous general anesthesia(TIVA)combined with quadratus lumborum block(QLB)were assigned to QLB group.All of patients accepted patient controlled intravenous analgesia(PCIA)for postoperative analgesia.Heart rate,blood pressure.and pulse oximetry were routinely monitored during anesthesia.The blocked area of patients was tested and recorded 15 minutes after quadratus lumborum block.Heart rate,blood pressure,and pulse oximetry were recorded beforrduring preoperative to discharge from PACU,2 hours,8 hours,12 hours,24 hours,48 hours after surgery.VAS scores and QOR-15 were obtained before surgery,2 hours,8 hours,12 hours,24 hours,48 hours after surgery.Opioids consumption during the operation and PCIA were also recorded.Additionally,postoperative complications such as nausea and vomiting,urinary retention,itching and respiratory depression during 48 hours after surgery were also recordedResultsThere was no significant difference in HR and SPO2 between the two groups(P>0.05).There were statistically significant differences in systolic blood pressure between the two groups at PACU,2 and 8 hours after surgery(P<0.05).The difference of diastolic blood pressure between the two groups was statistically significant 2 and 8 hours after surgery(P<0.05).The QoR-15 score of the QLB group was significantly higher than that of the control group at 2,12 and 24 hours after surgery(P<0.05).VAS scores in the QLB group were significantly lower than those in the control group at 2,8 and 12 hours postoperatively(P<0.05).The highest and the lowest block plane of the 12 patients in QLB group was T6(T6-T10)and Ll(T12-L1),respectively.Compared with the control group,the opioids consumption during the operation and PCIA of QLB group was significantly decreased and the difference was statistically significant(P<0.05).The patients in the QLB group needed additional analgesia for the first time was significantly later than those in the control group(P<0.05).ConclusionQuadratus lumborum block could effectively relieve postoperative acute pain in patients undergoing laparoscopic hepatectomy and reduce the opioids consumption during perioperative period,However,limited to the deficiency of retrospective study and the case number of current study,it still need design random controlled trial to evaluate the effect of quadratus lumborum block in postoperative acute pain of laparoscopic hepatectomy. |
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