Role Of Ultrasound Guided QLB In Enhanced Recovery After Pancreatic Surgery

Objective: To study the safety and efficiency of the ultrasound-guided Quadratus Lumborum block(QLB)in patients undergoing pancreatic surgery by the indices as the arterial blood concentration of ropivacaine,intraoperative hemodynamic stability,quality of recovery after anesthesia,quality of postoperative recovery and patient comfort and satisfaction after the surgery.Methods: 33 patient undergoing pancreatic surgery involving Chevron incision were recruited and among them 11 patients were treated with ultrasound-guided QLB with 3mg/kg ropivacaine as peripheral nerve blocking agent(QR group);11 patients were treated with 3 mg/kg ropivacaine and 0.5 mcg/kg dexmedetomidine as a blocking agent(QRD group)and the control group were treated with 0.8ml/kg NS as a blocking agent(QNS group).The arterial concentration of ropivacaine at different time points was collected and tested and compared between QR and QRD groups.Hemodynamic indexes were compared among the three groups.Similarly,the total anesthetic drugs and vasoactive drugs usage were also compared among the three groups.The extubation time,postoperative agitation,VAS pain score and PONV score at the different time point after surgery,Barthel score,various recovery parameters,comfort and satisfactory degree of the patient to anesthesia,postoperative complication and the quality of postoperative recovery was also compared among the three groups.A p-value of <0.05 was considered as significant difference.Results: Peak SBP after 15 min of skin incision and overall intraoperative period of the QNS group showed the significantly higher than peak SBP of the QR group and QRD group(all P<0.05).The mean sufentanil requirement of QR group was 9?g less when compared with QNS group,without any statistical significance.The mean propofol requirement during the operations of QR group and QRD group showed significantly less when compared with the QNS group(98±13mg,112±21mg vs 150±65,P< 0.05).Painscores at 6h after surgery and incidence of nausea at 48 h after the surgery in QR and QRD groups were also significantly lower than that of QNS group.The overall extubation time,postoperative recovery parameters,patient comfort and satisfaction and other parameters were better in QR group but the results were not statistically significant when compared with the QNS group.The mean concentrations of plasma ropivacaine at different time points after Quadratus Lumborum blockade in QRD group were lower than that of QR group,but there was no significant difference between this two groups.Conclusion: Ultrasound-guided QLB can improve the quality and efficiency of patients‘recovery after pancreatic surgery.The overall outcome of QR group was better than that of QRD although the QRD group received an extra 0.5 mcg/kg body weight of dexmedetomidine as a blocking agent.In addition,ropivacaine is safe and optimally effective at the concentration of 0.375% and dosage as 3mg/kg when used in the ultrasound-guided QLB.