经外侧弓状韧带上腰方肌前路阻滞在腹腔镜子宫全切术术后镇痛中的作用研究

Study on anterior quadratus lumborum block at the lateral supra-arcuate ligament for postoperative analgesia of LTH

摘要:

目的 探讨经外侧弓状韧带上腰方肌前路阻滞（AQLB-LSAL）在腹腔镜子宫全切术（LTH）术后镇痛中的作用。方法 选取2023年1月—2024年12月中山市小榄人民医院100例子宫肌瘤患者为研究对象，择期行LTH治疗，按照随机数字表法分为腹横肌平面阻滞（TAPB）组（最终纳入49例）与AQLB-LSAL组（最终纳入49例）。全身麻醉诱导前，TAPB组实施TAPB，AQLB-LSAL组实施AQLB-LSAL。统计两组术后不同时间点视觉模拟评分法（VAS）评分，比较两组手术前后血清前列腺素E2（PGE2）、P物质（SP）及神经肽Y（NPY）水平，并比较术中瑞芬太尼用量及术后48 h内补救镇痛率、舒芬太尼用量、患者自控静脉镇痛（PCIA）有效次数，以及不良反应发生率。结果 两组患者术后不同时间点静息时VAS评分比较，结果 ①不同时间点静息时VAS评分比较，差异有统计学意义（P <0.05）；②两组静息时VAS评分比较，差异有统计学意义（P <0.05）；③两组静息时VAS评分变化趋势比较，差异有统计学意义（P <0.05）。两组患者手术前后不同时间点血清PGE2、SP、NPY水平比较，结果 ①不同时间点PGE2、SP、NPY水平比较，差异均有统计学意义（P <0.05）；②两组PGE2、SP、NPY水平比较，差异均有统计学意义（P <0.05）；③两组PGE2、SP、NPY水平变化趋势比较，差异均有统计学意义（P <0.05）。AQLB-LSAL组术中瑞芬太尼用量及术后48 h内舒芬太尼用量、PCIA有效次数、补救镇痛率均低于TAPB组（P <0.05）。两组术后48 h内不良反应发生率比较，差异无统计学意义（P >0.05）。结论 相较于TAPB，AQLB-LSAL能降低子宫肌瘤患者LTH术后疼痛介质释放水平，有效减轻患者术后疼痛，还可减少阿片类镇痛药用量，具有一定安全性。

Abstract:

Objective To compare the efficacy of anterior quadratus lumborum block at the lateral supra-arcuate ligament (AQLB-LSAL) versus transversus abdominis plane block (TAPB) for postoperative analgesia after laparoscopic total hysterectomy (LTH).Methods One hundred uterine myoma patients undergoing LTH between January 2023 and December 2024 were randomized to TAPB (n = 49) or AQLB-LSAL (n = 49) groups before general anesthesia induction. Pain scores (VAS at rest), serum pain mediators (PGE2, SP, NPY), intraoperative remifentanil consumption, postoperative sufentanil consumption, patient-controlled intravenous analgesia (PCIA) demands, rescue analgesia rate, and adverse events within 48 hours were recorded.Results VAS scores at rest were significantly lower in the AQLB-LSAL group at all time points (P < 0.05). Changes in PGE2 and SP levels were significantly lower, and NPY significantly higher in the AQLB-LSAL group (P < 0.05). Intraoperative remifentanil, postoperative sufentanil consumption, PCIA demands, and rescue analgesia rate were significantly lower in the AQLB-LSAL group (P < 0.05). Adverse event rates were comparable (10.20% vs 16.33%, P > 0.05).Conclusions Compared to TAPB, AQLB-LSAL provides superior postoperative analgesia for LTH, reduces opioid consumption and pain mediator release (PGE2, SP), increases NPY, and demonstrates comparable safety.