The Observation Of Analgesic Effect When Ultrasound-guided Quadratus Lumborum Blockis Applied To Left Hemihepatectomy

Objective: To observe the analgesic effect of ultrasound-guided quadratus lumborum block(QLB)in left hemihepatectomyMethod:We selected 60 patients underwent left hemihepatectomy in our hospital during January 2018 to January 2019,who aged 30-70 years old,ASA I-III grade,then 60 patients were randomly divided into two groups,general anesthesia combined with QLB group(GQ Group),simple general anesthesia group(GA group),each has 30 patients in group.The anesthesia induction and intraoperative anesthesia management methods were consistent in both groups,and PCIA analgesia was conducted after surgery.The general condition of patients in two groups was recorded;the block level after 20 minutes of completion of the nerve block;MAP,HR during the resting state(T0),the time of incision(T1),the separation of the muscle layer(T2),and the separation of the parietal peritoneum(T3);5mins before surgery,the cortisol and blood glucose levels in the two groups when patients underwent left hepatectomy and suture;intraoperative sufentanil dose,initial PCIA compression time and total number of PCIA compression;MAP,HR,and SpO2 at 3h(T4),6h(T5),24h(T6),and 48h(T7)after operation were recorded separately;resting and exercise at T4,T5,T6,and T7 after operation were scored by VAS;Observe and count PCIA complications(nausea,vomiting,sweating,dizziness,lethargy,itching,hypotension,respiratory depression)and complications related to nerve block.Results:(1)General conditions of the two groups of patients,there was no significant difference in SpO2(P>0.05)MAP,HR at each time point after surgery.(2)After the nerve block is completed for 20 minutes,the block level is mainly located between T7-L1.In the GA group,the MAP and HR of T1,T2,and T3 increased significantly compared with T0,Patients in the GQ group had no significant change in MAP,HR at T1,T2,and T3 compared with T0,MAP,HR are smaller in GQ groups than that in GA groups at T1,T2,T3 except at T0(P <0.05).(3)There was no significant difference in blood glucose and cortisol levels between the GQ group and the GA group(P>0.05).While in Left hepatectomy and suture,the blood glucose and cortisol levels in the GQ group were lower than those in the GA group(P<0.05).(4)In the GQ group,the use of sufentanil was lower than that in the GA group,and the first PCIA compression time was longer than that in the GA group,the total number of postoperative PCIA was significantly lower than that in the GA group(P<0.05),the resting and exercise VAS scores measured by TQ,T5 and T6 in the GQ group were lower than those in the GA group(P<0.05),the VAS scores measured at the T7 time point were not different from those in the GA group(P>0.05).(5)Postoperative nausea and vomiting in the GQ group were lower than those in the GA group(P<0.05),and the incidence of other PCIA complications was lower,there was no significant difference between the two groups,no complications related to nerve block were found.Conclusion: Better analgesic effect were exerted when ultrasound-guided quadratus lumborum block is applied to left hemihepatectomy.The performance is displayed as :(1)The usage of intraoperative analgesics is less,stress response is mild,hemodynamic is stable.(2)The usage of postoperative analgesics is small,and there are few anesthesia-related complications.