Study on analgesic effect of anterior quadratus lumborum block at lateral supra-arcuate ligament and transversus abdominis plane block in analgesia in patients undergoing laparoscopic partial hepatectomy

doi:10.11958/20230884

Abstract

Abstract:

Objective To observe the effect of ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament (QLB-LSAL) and transversus abdominis plane block (TAPB) on analgesia and recovery quality after laparoscopic partial hepatectomy (LPH). Methods Fifty-eight patients underwent elective LPH were selected and divided into the quadratus lumborum group or the transversus abdominis group randomly, with 29 patients in each group. The quadratus lumborum group received bilateral QLB-LSAL, and the transversus abdominis group received bilateral subcostal TAPB block before surgery. Both groups received 20 mL of 0.33% ropivacaine on each side. All patients used patient-controlled intravenous analgesia (PCIA) postoperatively. The numeric rating scale (NRS) scores for rest and movement were recorded at 2, 4, 6, 12, 24 and 48 hours postoperatively, as well as the Quality of Recovery-15 (QoR-15) scores at 1 day preoperatively, 1 and 3 days postoperatively. The perioperative anesthetic agent consumption, PCIA pressing frequency, remedial analgesia use in 48 h, postoperative nausea and vomiting (PONV) incidence and time of first out-of-bed mobilization were also recorded. Results Compared with the transversus abdominis group, the quadratus lumborum group had lower movement NRS scores at 2, 4, 6, 12, 24 and 48 hours postoperatively, and lower rest NRS scores at 2, 4, 6, 12 and 24 hours postoperatively (P<0.05). The quadratus lumborum group had higher QoR-15 scores at 1 and 3 days postoperatively (P<0.05). Patients in the quadratus lumborum group had reduced perioperative remifentanil and sufentanil consumption, postoperative 48-hour rescue analgesia use, PCIA pressing frequency, PONV incidence and time of first out-of-bed mobilization (P<0.05). Conclusion QLB-LSAL block provides superior analgesic effects and recovery quality compared to TAPB block after LPH.

Key words: anesthesia, pain, postoperative, anesthesia recovery period, abdominal transverse muscle plane block, anterior lumbar quadratus muscle block on the arcuate ligament

CLC Number:

R614.4

Figures/Tables 5

References 15

[1]	ELSHARKAWY H, EL-BOGHDADLY K, BARRINGTON M. Quadratus lumborum block:anatomical concepts,mechanisms,and techniques[J]. Anesthesiology, 2019, 130(2):322-335. doi:10.1097/ALN.0000000000002524.
[2]	PENUELA L, DBRASS T J, TUBOG T D. Use of transversus abdominis plane block in hysterectomy:a systematic review[J]. J Perianesth Nurs, 2023, 38(2):331-338. doi:10.1016/j.jopan.2022.06.017.
[3]	LI H, MA D, LIU Y, et al. A transverse approach for ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament[J]. Anaesthesia, 2020, 75(10):1400-1401. doi:10.1111/anae.15058.
[4]	廖春英, 王云, 李慧利, 等. 超声引导下外侧弓状韧带上腰方肌前路阻滞与腹横肌平面阻滞在子宫切除术中的比较[J]. 临床麻醉学杂志, 2022, 38(7):716-720.
	LIAO C Y, WANG Y, LI H L, et al. Comparison of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament and transversus abdominis plane block in hysterectomy[J]. J Clin Anesthesiol, 2022, 38(7):716-720. doi:10.12089/jca.2022.07.009.
[5]	LI H, SHI R, SHI D, et al. Anterior quadratus lumborum block at the lateral supra-arcuate ligament versus transmuscular quadratus lumborum block for postoperative analgesia in patients undergoing laparoscopic nephrectomy:a randomized controlled trial[J]. J Clin Anesth, 2021, 12(75):110561. doi:10.1016/j.jclinane.2021.110561.
[6]	O'NEILL A, LIRK P. Multimodal analgesia[J]. Anesthesiol Clin, 2022, 40(3):455-468. doi:10.1016/j.anclin.2022.04.002.
[7]	PRABHAKAR P, GANAPATHI H P, SURESH V, et al. Surgeon administered transversus abdominis plane block:anatomic principles and technique[J]. J Robot Surg, 2023, 17(4):1193-1205. doi:10.1007/s11701-023-01535-9.
[8]	WESSELS E, PERRIE H, SCRIBANTE J, et al. Quality of recovery in the perioperative setting:a narrative review[J]. J Clin Anesth, 2022, 6(78):110685. doi:10.1016/j.jclinane.2022.110685.
[9]	CHOI J, LEE H S, KIM J Y, et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery:a randomized non-inferiority trial[J]. J Clin Anesth, 2022, 11(82):110955. doi:10.1016/j.jclinane.2022.110955.
[10]	ELSHARKAWY H, AHUJA S, SESSLER S, et al. Subcostal anterior quadratus lumborum block versus epidural block for analgesia in open nephrectomy:a randomized clinical trial[J]. Anesth Analg, 2021, 132(4):1138-1145. doi:10.1213/ANE.0000000000005382.
[11]	EL-BOGHDADLY K, ELSHARKAWY H, SHORT H, et al. Quadratus lumborum block nomenclature and anatomical considerations[J]. Reg Anesth Pain Med, 2016, 41(4):548-549. doi:10.1097/AAP.0000000000000411.
[12]	LI H, SHI R, WANG Y. Transincisional ultrasound-guided quadratus lumborum block in open renal surgeries[J]. Pain Physician 2021, 24(1):E127-E128.
[13]	LI H, LIANG J, SHAO P, et al. Supra-arcuate ligament blocks:anatomy,mechanisms,and techniques[J]. J Pain Res, 2021, 15(14):3837-3848. doi:10.2147/JPR.S347071.
[14]	GUO M, LEI B, LI H, et al. Anterior quadratus lumborum block at the lateral supra-arcuate ligament versus transmuscular quadratus lumborum block for analgesia after elective cesarean section:a randomized controlled trial[J]. J Clin Med, 2022, 11(13):3827. doi:10.3390/jcm11133827.
[15]	邱晟, 许汀, 郭晓明, 等. 弓状韧带上腰方肌前侧阻滞用于胸腔镜肺叶切除术患者术后镇痛的效果[J]. 临床麻醉学杂志, 2022, 38(12):1237-1241.
	QIU C, XU D, GUO X M, et al. Postoperative analgesic effect of anterior quadratus lumborum block at the supra-arcuate ligament in patiment undergoing thoracoscopic plumonary lobectomy[J]. J Clin Anesthesiol, 2022, 38(12):1237-1241. doi:10.12089/jca.2022.12.001.

组别	性别（男/女）	年龄/岁	ASA分级（Ⅱ/Ⅲ）	BMI/ （kg/m²）
弓状韧带组	16/13	54.93±12.91	22/7	22.52±2.16
腹横平面组	18/11	57.07±10.40	20/9	22.36±1.78
χ²或t	0.284	0.694	0.345	0.312

组别	性别（男/女）	年龄/岁	ASA分级（Ⅱ/Ⅲ）	BMI/ （kg/m²）
弓状韧带组	16/13	54.93±12.91	22/7	22.52±2.16
腹横平面组	18/11	57.07±10.40	20/9	22.36±1.78
χ²或t	0.284	0.694	0.345	0.312

组别	手术时间/min	麻醉时间/min	术后住院时间/d
弓状韧带组	227.0（162.0，395.5）	253.0（197.0，394.5）	8（6，10）
腹横平面组	246.0（178.5，343.5）	270.0（203.0，377.5）	8（6，10）
Z	0.101	0.163	0.461

组别	手术时间/min	麻醉时间/min	术后住院时间/d
弓状韧带组	227.0（162.0，395.5）	253.0（197.0，394.5）	8（6，10）
腹横平面组	246.0（178.5，343.5）	270.0（203.0，377.5）	8（6，10）
Z	0.101	0.163	0.461

组别	静息NRS评分
组别	2 h	4 h	6 h	12 h	24 h	48 h	F
弓状韧带组	2.24±0.51	2.38±0.49	3.03±0.91	2.97±0.50	2.38±0.49	2.07±0.65	10.379^＊＊
腹横平面组	3.17±0.60	3.28±0.80	3.66±0.61	3.45±0.69	2.79±0.62	2.21±0.73	16.870^＊＊
F	40.340^＊＊	26.510^＊＊	9.333^＊＊	9.397^＊＊	7.906^＊＊	0.580
组别	运动NRS评分
组别	2 h	4 h	6 h	12 h	24 h	48 h	F
弓状韧带组	2.41±0.63	2.48±0.51	3.17±0.97	3.24±0.69	2.66±0.55	2.17±0.47	13.341^＊＊
腹横平面组	3.28±0.75	3.45±0.91	4.10±0.72	3.79±0.77	3.10±0.56	2.45±0.51	31.620^＊＊
F	22.494^＊＊	24.889^＊＊	17.240^＊＊	8.220^＊＊	9.464^＊＊	4.642^＊