Comparison of anesthetic effect and safety of two nerve block methods under ultrasound guidance in laparoscopic total hysterectomy

doi:10.11958/20253133

Abstract

Abstract:

Objective To compare the efficacy and safety of ultrasound-guided anterolateral lumbar flexus block over the arcuate ligament with transversus abdominis plane block (TAPB) for anesthesia in laparoscopic total hysterectomy. Methods A total of 120 patients who underwent laparoscopic total hysterectomy at our hospital between October 2020 and October 2023 were selected and randomly assigned to two groups using a random number table. The control group underwent TAPB under ultrasound guidance preoperatively, while the observation group received bilateral pre-quadratus lumborum block over the arcuate ligament under ultrasound guidance. Both groups received patient-controlled intravenous analgesia (PCIA) postoperatively. The following parameters were compared between the two groups, including hemodynamic status, intraoperative remifentanil consumption, intraoperative propofol consumption, stress response, visual analog scale (VAS) scores, analgesic efficacy and postoperative recovery indicators. Results The heart rate and mean arterial pressure at intubation (T1) and extubation (T2) were higher in both groups than those at admission (T0), and those were lower in the observation group than the control group (P<0.05). The dosage of remifentanil was less during surgery in the observation group than those of the control group, while there was no significant difference in propofol usage between the two groups (P>0.05). At the end of surgery and 24 hours postoperatively, levels of epinephrine (AE), dopamine (DA) and norepinephrine (NE) were elevated in both groups compared to preoperative levels. However, these levels were lower in the observation group than those in the control group at both time points (P<0.05). The VAS scores of pain at rest and during exercise at 6, 12, 24 and 48 hours after surgery were lower in the observation group than those in the control group. The number of compressions of the analgesic pump, the rate of remedial analgesia, the time to get out of bed and move around, and the time to first exhaust were less in the observation group than those in the control group (P<0.05). Conclusion Ultrasound-guided anterolateral block of the superior lumbar quadratus muscle over the arcuate ligament for use in laparoscopic total hysterectomy can stabilize haemodynamics, reduce body stress response and provide good analgesia.

Key words: hysterectomy, laparoscopy, nerve block, ultrasound-guided anterolateral lumbar flexus block on the arcuate ligament, transversus abdominis plane block

CLC Number:

R614.4

Figures/Tables 6

References 21

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组别	年龄/岁	入院诊断		ASA分级
组别	年龄/岁	子宫肌瘤	子宫肌腺病	Ⅰ级	Ⅱ级
对照组	46.56±5.62	38（63.33）	22（36.67）	25（41.67）	35（58.33）
观察组	47.14±5.55	40（66.67）	20（33.33）	29（48.33）	31（51.67）
t或χ²	0.569	0.147		0.539

组别	年龄/岁	入院诊断		ASA分级
组别	年龄/岁	子宫肌瘤	子宫肌腺病	Ⅰ级	Ⅱ级
对照组	46.56±5.62	38（63.33）	22（36.67）	25（41.67）	35（58.33）
观察组	47.14±5.55	40（66.67）	20（33.33）	29（48.33）	31（51.67）
t或χ²	0.569	0.147		0.539

组别	心率/（次/min）
组别	T0	T1		T2		T3
对照组	78.95±8.54	97.19±9.71^a		95.56±7.33^a		80.12±9.04^b
观察组	79.01±7.93	88.74±7.83^a		87.05±8.04^a		78.98±7.83^b
t	0.040	5.247^＊＊		6.059^＊＊		0.738
F_组间/F_时间/F_交互	34.125^＊＊/96.926^＊＊/9.240^＊＊
组别	平均动脉压/mmHg
组别	T0	T1	T2		T3
对照组	89.85±6.75	98.86±5.88^a	99.41±6.03^a		90.10±6.08^b
观察组	90.11±5.93	95.57±5.73^a	94.30±5.46^a		89.63±5.75^b
t	0.224	3.104^＊＊	4.866^＊＊		0.435
F_组间/F_时间/F_交互	13.805^＊＊/52.551^＊＊/4.860^＊＊

组别	心率/（次/min）
组别	T0	T1		T2		T3
对照组	78.95±8.54	97.19±9.71^a		95.56±7.33^a		80.12±9.04^b
观察组	79.01±7.93	88.74±7.83^a		87.05±8.04^a		78.98±7.83^b
t	0.040	5.247^＊＊		6.059^＊＊		0.738
F_组间/F_时间/F_交互	34.125^＊＊/96.926^＊＊/9.240^＊＊
组别	平均动脉压/mmHg
组别	T0	T1	T2		T3
对照组	89.85±6.75	98.86±5.88^a	99.41±6.03^a		90.10±6.08^b
观察组	90.11±5.93	95.57±5.73^a	94.30±5.46^a		89.63±5.75^b
t	0.224	3.104^＊＊	4.866^＊＊		0.435
F_组间/F_时间/F_交互	13.805^＊＊/52.551^＊＊/4.860^＊＊

组别	丙泊酚用量	瑞芬太尼用量
对照组	248.56±12.03	1.50±0.05
观察组	245.41±13.28	1.27±0.04
t	1.362	27.823^＊＊