Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Laparoscopic Colorectal Surgery

Background: Transmuscular Quadratus Lumborum Block (TQLB) is a newer modality for postoperative pain management. But, its efficacy after laparoscopic colorectal surgery is little researched. The aim of our trial was to access the analgesic efficacy of TQLB in colorectal surgery.Methods:This study was done in 64 patients posted for colorectal surgery who were divided into two groups of 32 each. TQLB was given bilaterally in group RQ with 20 ml of 0.375% ropivacaine and in group SQ with 20 ml saline. Patients were operated under general anesthesia and were examined for pain at different time points postoperatively. Time required for first analgesic demand was our primary endpoint. Secondary endpoints were total rescue analgesia (paracetamol) required in 24 hrs, pain scores, nausea, vomiting, sedation and any other complications.Results:The time required for first analgesic demand was 3.9� 0.8hrs in RQ group and 0.1� 0.2 hrs in group SQ which was statistically significant. The total paracetamol consumption in 24 hours was1.2� 0.4 gm in group RQ and 2.9� 0.7gm in group SQ ,the difference being remarkable.Conclusion:Transmuscular quadratus lumborum block can produce quality analgesia after laparoscopic colorectal surgery. TQLB not only improves the visual analogue scale (VAS) score but also decreases the rescue analgesic consumption without any complications.

Quadratus Lumborum Block for Upper Tract Urological Surgery in Pediatric Patients / Bloqueo del cuadrado lumbar para cirugía urológica del tracto superior en pacientes pediátricos

Objective Among regional blocks, the quadratus lumborum fascial plane block (QLB) has been well described, but the description of its use and efficacy for pediatric patients undergoing upper abdominal urologic surgery is limited. We present a case series examining the use of the QLB for postoperative pain management in children undergoing upper tract surgery. Methods From August 2019 to August 2020, through a chart review, we identified 5 patients who had undergone a QLB for upper urinary tract surgery via a flank incision. Posterior QLB was performed after induction of general anesthesia. A single injection of 0.5mL/kg of either 0.25% or 0.5% ropivacaine with 1mcg/kg of clonidine was administered. Patients received fentanyl IV (1 mcg/kg), and acetaminophen IV (15mg/kg) as adjuvants during the operation. Postoperative pain was managed with oral acetaminophen and ibuprofen. Results The average postoperative pain score during the entire admission was 1, with the lowest being 0 and highest, 3. No administration of rescue narcotics was required in the postanesthesia care unit or on the floor. The average length of stay ranged from 0 to 1 day. No complications associated with the regional QLB were identified. Conclusions Our series suggests the QLB may be considered as a regional anesthetic option to minimize narcotic requirements for children undergoing upper abdominal urological surgery via flank incision. Additional studies are needed to compare the efficacy of the QLB versus alternate regional anesthetic blocks for upper tract urological surgery via flank incision in children and to determine effective dosing and use of adjuvants

Objetivo Entre los bloqueos regionales, el bloqueo del plano fascial del cuadrado lumbar (BCL) ha sido bien descrito; sin embargo, tiene una descripción limitada de su uso y eficacia en pacientes pediátricos sometidos a cirugía urológica abdominal superior. Presentamos una serie de casos que examinan el uso del BCL en el manejo del dolor posoperatorio en niños sometidos a cirugía urológica del tracto superior. Métodos De agosto de 2019 a agosto de 2020, mediante revisión de historias clínicas, se identificaron 5 pacientes sometidos al BCL para cirugía del tracto urinario superior por incisión en el flanco. El BCL posterior se realizó después de la inducción de la anestesia general. Solo se administró una inyección de 0,5 ml/kg de ropivacaína al 0,25% o al 0,5% con 1 mcg/kg de clonidina. Los pacientes recibieron fentanilo IV (1 mcg/kg) y acetaminofén IV (15 mg/kg) como adyuvantes durante la operación. El dolor posoperatorio se manejó con acetaminofén e ibuprofeno oral. Resultados El puntaje promedio de dolor posoperatorio para todo el ingreso fue de 1, siendo el más bajo 0 y el más alto, 3. No se requirieron administraciones de narcóticos de rescate en la unidad de recuperación posanestésica ni en la planta de hospitalización. La estancia media fue de 0 a 1 día. No se identificaron complicaciones asociadas con el BCL regional. Conclusiones Nuestra revisión sugiere que el BCL puede ser considerado una opción anestésica regional para minimizar los requerimientos de narcóticos en niños sometidos a cirugía urológica abdominal superior por incisión en el flanco. Se necesitan estudios adicionales para comparar la eficacia de BCL en comparación con la de los bloqueos anestésicos regionales alternativos para la cirugía urológica del tracto superior por incisión en el flanco en niños y para determinar la efectividad de la dosificación y del uso de adyuvantes.

Evaluación del bloqueo del cuadrado lumbar transmuscular ecoguiado en pediatría / Efficacy of ultrasound-guided transmuscular quadratus lumborum block in children

OBJECTIVES:Transmuscular quadratus lumborum block (TQLB) is a novel regional anaesthesia technique that has proven to be effective for postoperative pain reduction in different abdominal surgical procedures. The present study evaluated its efficacy on pain intensity and analgesic consumption in children undergoing low abdominal surgery. METHODS: The study included forty patients, aged 1 to 6 years, scheduled for low abdominal surgery (hernia repair or orchiopexy) under general anaesthesia. They were enrolled in two groups: TQLB block plus systemic analgesia (group 1; n = 20) wound infiltration done by the surgeon plus systemic analgesia (Group 2; n = 20). All blocks were performed by the same anesthesiologist under general anaesthesia before surgery. Both groups received the same systemic analgesia protocol. Analgesic consumption (ibuprofen) within the first 24 postoperative hours, pain intensity scores (FLACC scale) at 60 minutes, 2, 6 and 24 hours after surgery, time in which the first analgesia was required, satisfaction levels of the parents (0-10), adverse events related to systemic analgesia and time to hospital discharge were evaluated and registered. RESULTS: We found differences between both groups in ibuprofen consumption (80 mg 185 mg; p < 0.05) and pain scores (FLACC) within the first 24 postoperative hours at each interval (p < 0.05 for every point in time analyzed). Time in which the first analgesia was required was longer for the TQLB group (18 10 hours; p < 0.05). Satisfaction levels of the parents were also higher in the first group (p < 0.05). Adverse events related to medication and time to hospital discharge showed similar results. Further investigation comparing the TQLB with different approaches of QLB or conventional TAP block could be interesting and is required in a near future.

INTRODUCCIÓN: El bloqueo del cuadrado lumbar transmuscular (TQL) es una técnica de anestesia regional ecoguiada que demostró ser efectiva en cirugía abdominal abierta y laparoscópica como parte de un esquema multimodal de analgesia postoperatoria. La presente investigación evaluó su eficacia en cirugía de hernia inguinal y testículo no descendido en población pediátrica (de 1-6 años de edad). MATERIALES Y MÉTODOS: El estudio fue diseñado como un ensayo clínico controlado, aleatorizado en 2 ramas: grupo protocolo bloqueo TQL (Grupo 1; n = 20) grupo protocolo infiltración local por cirujano (Grupo 2; n = 20), simple ciego que incluyó a 40 pacientes pediátricos sometidos a una cirugía de hernia inguinal u orquidopexia unilateral. Todos los bloqueos fueron realizados bajo anestesia general antes del inicio de procedimiento quirúrgico. Ambos grupos recibieron el mismo esquema de analgesia endovenosa y oral postoperatoria. Consumo de analgésicos durante las primeras 24 horas (mg de ibuprofeno), intensidad de dolor con escala FLACC a tiempo 1, 2, 6 y 24 horas postoperatorias, tiempo transcurrido a la primera administración de ibuprofeno, escala de satisfacción parental (0-10) e incidencia de náuseas y vómitos fueron evaluados y registrados. Se consideró como significativa una p < 0,05. RESULTADOS: El consumo promedio de ibuprofeno en las primeras 24 horas fue de 80 mg para el grupo bloqueo TQL y de 185 mg para el segundo grupo, diferencia estadísticamente significativa (p < 0,05). El tiempo transcurrido a la primera administración de ibuprofeno fue mayor en el grupo TQL (18 10 horas), p < 0,05. Las escalas de dolor por FLACC a los 60 y 120 minutos y a las 6 y 24 horas. postcirugía fueron menores comparadas con el grupo de infiltración local por el cirujano (p < 0,05 en cada punto de análisis). Las escalas de satisfacción parental mostraron puntajes más elevados para el grupo que recibió el bloqueo TQL (p < 0,05). No se hallaron diferencias significativas en la incidencia de episodios de náuseas y/o vómitos en las primeras 24 horas. postoperatorias (p > 0,2). No se reportaron complicaciones asociadas al bloqueo. CONCLUSIONES: Este estudio muestra que el bloqueo TQL aporta beneficios adicionales respecto al plan de analgesia estándar empleado en cirugía de hernia inguinal unilateral u orquidopexia, disminuyendo el requerimiento de analgésicos y la intensidad de dolor en las primeras 24 horas postoperatorias, así como también incrementando la satisfacción de los cuidadores respecto al estado postoperatorio del niño. Sería interesante llevar a cabo nuevas investigaciones comparando esta técnica con otros abordajes del bloqueo de cuadrado lumbar y con el cuestionado bloqueo TAP convencional.

Comparison of postoperative pain between ultrasound-guided quadratus lumborum block versus ultrasound-guided caudal epidural block in children 1-6 years old undergoing unilateral lower abdominal and urological surgeries in Philippine Children's Medical Center: A randomized controlled trial

@#<p><strong>BACKGROUND:</strong> Ultrasound?guided quadratus lumborum block (QLB) is a regional anesthetic technique which can provide post-op pain control for pediatric patients undergoing abdominal surgery. We hypothesized that the quadratus lumborum block would be as efficacious as a caudal block in providing pain control.</p><p><strong>OBJECTIVE:</strong> To compare the postoperative analgesic effect of ultrasound-guided QLB versus ultrasound-guided caudal block among 1-6 years old children undergoing lower abdominal and urological surgeries in Philippine Children's Medical Center.</p><p><strong>METHODS:</strong> This is a single-blinded randomized control trial. 50 patients enrolled aged between 1 and 6 years. The patients were randomly classified into the caudal block group and quadratus lumborum block group. The primary outcome is the need for analgesia during the first 24 hours.</p><p><strong>RESULTS:</strong> A significant difference in the proportion of patients who requested for rescue analgesia was observed with caudal block having more patients in need of analgesic (100% CB vs 48% QLB, p<0.001). No postoperative complication was observed.</p><p><strong>CONCLUSIONS AND RECOMMENDATIONS:</strong> The quadratus lumborum block was more effective in reducing the postoperative pain management during the initial 48 hours. Quadratus lumborum block is recommended for future pediatric procedures requiring postoperative pain control, safety, practicality and economy.</p>

Continuous quadratus lumborum type 3 block provides effective postoperative analgesia for hip surgery: case report / O bloqueio contínuo do quadrado lombar tipo 3 fornece analgesia pós-operatória efetiva para cirurgia do quadril: relato de caso

Abstract Introduction: Hip surgery is a major surgery that causes severe postoperative pain. Although pain during rest is usually considerably reduced mobilization is important in terms of thromboembolic complications. The quadratus lumborum block is a regional analgesic technique that blocks T6-L3 nerve branches. This block may provide adequate analgesia and reduce opioid consumption after hip surgery. Case report: We performed continuous quadratus lumborum type 3 block in two patients who underwent hip arthroplasty. Postoperative 24-h pain scores, local anesthetic consumptions on patient-controlled analgesia and additional analgesic requirement were recorded. In two patients, postoperative pain scores were less than 6 during rest and physiotherapy. Patient was mobilized in the early postoperative period without additional opioid analgesic requirement and without muscle weakness. Discussion: Continuous quadratus lumborum block may be used to relieve postoperative acute pain in hip surgery because it provides one-sided anesthesia without muscle weakness.

Resumo Introdução: A cirurgia de quadril é uma cirurgia de grande porte que causa dor intensa no pós-operatório. Embora a dor durante o repouso seja consideravelmente reduzida, a mobilização é importante em termos de complicações tromboembólicas. O bloqueio doquadrado lombar é uma técnica analgésica regional que bloqueia os ramos nervosos de T6-L3. Esse bloqueio pode fornecer analgesia adequada e reduzir o consumo de opioides após cirurgiasde quadril. Relato de caso: Realizamos o bloqueio contínuo do quadrado lombar tipo 3 em dois pacientes submetidos à artroplastia de quadril. Durante as 24 hs de pós-operatório foram registrados os escores de dor, o consumo de anestésicos locais em analgesia controlada pelo paciente e a necessidade de analgésicos adicionais. Em dois pacientes, os escores de dor pós-operatória foram < 6 durante o repouso e fisioterapia. O paciente foi mobilizado no período pós-operatório imediato, sem precisar de analgésico opioide adicional e sem fraqueza muscular. Discussão: O bloqueio contínuo do quadrado lombar pode ser usado para aliviar a dor aguda no pós-operatório de cirurgia de quadril porque fornece anestesia unilateral sem fraqueza muscular.

Effect of enhanced recovery after surgery concept in pediatric patients of abdomen surgery / 临床麻醉学杂志

Objective To observe the clinical effect of ultrasound-guided quadratus lumborum block combined with enhanced recovery after surgery (ERAS) for the laparoscopic appendectomy in children. Methods A total of 154 children undergoing laparoscopic appendectomy, 114 males and 40 females, aged 3-10 years, ASA physical status Ⅰ or Ⅱ, were divided into the ERAS group (group E) and control group (group C), n = 77 each group. Patients in group E received ultrasound-guided deep injection of 0.2％ ropivacaine 0.75 ml/kg into quadratus lumbar muscle. According to the guidelines for rapid rehabilitation fasting for 4 h and abstaining from drinking for 2 h, functional beverages were given 30 min before operation and parental escort during induction of anesthesia while given general anesthesia with laryngeal mask, that is, propofol 2-6 mg·kg-1·h-1 was continuously pumped with 2％-6％ sevoflurane. Patients in group C were given traditional anesthesia, strict fasting for 6 h and no drinking for 4 h, as while as induction with midazolam, propofol, atracurium and sufentanil and tracheal intubation. The VAS scores at 2, 3, 6 and 12 h post-operation were recorded. The awakening time, anal exhaust time, ambulation time, hospitalization days, the patient's satisfaction rates were recorded. The cases of nausea, vomiting, regurgitation and aspiration were recorded. Results The VAS scores at 2, 3, 6 and 12 h post-operation in group E were significantly lower than that in group C (P ＜ 0.05). All the postoperative rehabilitation indicators in group E were superior to group C, including the awakening time, anal exhaust time, ambulation time, hospitalization days and patient's satisfaction (P ＜ 0.05). Complication incidences in group E were significantly declined compared with group C (P ＜ 0.05). Conclusion For children undergoing laparoscopic appendectomy, ultrasound-guided quadratus lumborum block combined with the ERAS strategy could result in less postoperative complications, reduced postoperative pain, rapid rehabilitation, shortened hospitalization time and increased patients' satisfaction.

Effects of ultrasound-guided quadratus lumborum block on postoperative analgesia after caesarean section / 临床麻醉学杂志

Objective To investigate the effect of ultrasound-guided quadratus lumborum block (QLB) on postoperative analgesia after caesarean section.Methods Sixty parturientsscheduled for cesarean section, aged 20-40 years, ASA physical status Ⅰ orⅡ, were randomly divided into 2 groups (n = 30 each) using a random number table:QLB group (group Q) and control group (group C).Parturients in group Q received bilateral QLB with the use of 20 ml 0.33％ ropivacaine per side after surgery, while QLB was not done in group C.Both groups received patient-controlled intravenous analgesia (PCIA) after surgery which contains 800 mg tramadol, 40 mg nefopam and 80 ml normal saline.The accumulative consumption of tramadol, the score of numerical rating scale (NRS) for pain at rest and on movement and the bruggrmann comfort scale (BCS) score were recorded at 4, 8, 12, 24, 48 hafter operation.The cutaneous sensory block area was determined in group Q at 4, 8, 12, 24, 48 hafter operation.The patient′s satisfaction with postoperative analgesia and adverse reactions were also recorded.Results The consumption of tramadol in group Q was significantly decreased compared with that in group C (P<0.05) at 4, 8, 12, 24, 48 hafter surgery.NRS for pain at rest at all times, NRS for pain when cough at 12, 24 hafter surgery and NRS for pain when turning over at 4, 48 hafter surgery were significantly lower, while the BCS score was higher in group Q than that in group C (P<0.05).Quadratus lumborum block affected T7-L1 dermatomes at 4, 8, 12 hafter surgery and T8-L1 dermatomes at 24 hafter surgery.The analgesic plane of quadratus lumborum block disappeared at 48 hours after operation.The patient's satisfaction with postoperative analgesia was higher in group Q compared with that in group C (P<0.05).The incidence of postoperative nausea, vomiting and dizziness was similar between the two groups.Conclusion Ultrasound-guided quadratus lumborum block can remarkably reduce the consumption of tramadol after caesarean section, lower the postoperative pain score, improve the patient′s comfort and satisfaction.

Effect and mechanism of ultrasound-guided quadratus lumborum block on postoperative early cognitive function after colorectal surgery / 临床麻醉学杂志

Objective To investigate the effect of ultrasound-guided quadratus lumborum block on cognitive function after laparoscopic colorectal surgery.Methods Seventy-six patients, there is no restriction on gender, aged 50-75 years, falling into ASA physical statusⅡorⅢ, who provided informed consent for their participation in this study and underwent colorectal surgery under general anesthesia were divided into two groups (groups Q and C).Induction of anesthesia was induced by intravenous midazolam 0.03 mg/kg, sufentanil 0.5μg/kg, etomidate 0.3 mg/kg and rocuronium 1 mg/kg in the two groups.Remifentanil 0.2-0.3μg·kg-1·min-1 and propofol 0.10-0.15 mg·kg-1·min-1 were maintained intravenously during anesthesia.0.375％ropivacaine 20 ml was injected between the psoas quadratus muscle and psoas major muscle under ultrasound guidance before extubation in group Q, only equal volume saline was given in group C.Neuropsychological tests were performed preoperatively as well as postoperative day 7.The postoperative pain was evaluated by VAS after surgery.The postoperative sleep quality was measured using a BIS-vista monitor.The changes of serum IL-6, IL-1β, TNF-αand CGRP levels were detected by ELISA at immediately after operation (T0), 1 hour (T1), 2 days (T2), 4 days (T3) and 7 days (T4) after operation.Results Seventy-six patients finished cognitive function tests (38 cases in group Q and 38 cases in group C), 12 cases (31.6％) were diagnosed as POCD in group C, 4 cases (10.5％) in group Q.Compared with group C, the incidence of POCD, VAS scores at 24 and 48 hours after operation in group Q were significantly lower (P<0.05), the sleeping time at night was longer, the serum levels of IL-6, IL-1βand TNF-αwere significantly lower at T2 and T3, and the serum levels of CGRP were significantly higher at T2-T4 (P<0.05 or P<0.01).Conclusion QLB treatment repaired the surgery induced early cognitive dysfunction by inhibiting the postoperative pain, excessive inflammatory response and improving the quality of sleep.

Hypotension associated to a bilateral quadratus lumborum block performed for post-operative analgesia in an open aortic surgery case / Hipotensão associada ao bloqueio bilateral do quadrado lombar realizado para analgesia pós-operatória em caso de cirurgia aórtica aberta

Abstract Background and objectives: Bilateral quadratus lumborum block has been described for major abdominal procedures when sepsis is present, because risks associated to epidural are considered elevated. In an open aortic surgery, a single-shot bilateral quadratus lumborum block type 1 may be an alternative to thoracic epidural block for post-operative analgesia in a patient having an increased cumulative risk for thoracic epidural hematoma. Case report: A 56-year-old female patient presenting controlled hypertension, chronic renal disease stage 3b, dyslipidemia and a platelet count of 102,000/µl, and taking aspirin, was scheduled for bilateral aortoiliac endarterectomy. She was submitted to a sole general anesthesia plus, at end of the surgery, a bilateral quadratus lumborum block type 1 for post-operative analgesia with 20 mL of ropivacaine 0.5%, per side, before extubation. Immediately after post anesthesia care unit admission, patient developed moderate hypotension (dopamine infusion was needed during 18 h), concomitantly with a rapid reduction in the pain scores. Low numeric rating scale and opioid consumption were noted, particularly in the first 24 h post-operatively. Conclusions: Quadratus lumborum block was an effective analgesic technique for open aortic surgery in this case, although hypotension associated to bilateral quadratus lumborum block type 1 may occur. Associated sympathetic block probably related to the bilateral paravertebral extension of the block, may contribute for post-operative hypotension associated to reperfusion-ischemia syndrome in a patient that had long-lasting intraoperative aortic cross-clamping. The use of high concentration of local anesthetic to obtain longer duration of action of a single-shot quadratus lumborum block to avoid thoracic epidural or bilateral quadratus lumborum block catheterization should be used judiciously.

Resumo Justificativa e objetivos: O bloqueio bilateral do quadrado lombar foi descrito para procedimentos abdominais de grande porte quando há presença de sepse, uma vez que os riscos associados à peridural são considerados altos. Em uma cirurgia aórtica aberta, um único bloqueio bilateral do quadrado lombar tipo 1 (QL tipo 1) pode ser uma opção ao bloqueio peridural torácico para analgesia pós-operatória em paciente com risco cumulativo aumentado de hematoma epidural torácico. Relato de caso: Paciente feminina de 56 anos, portadora de hipertensão arterial controlada, doença renal crônica (estágio 3 b), dislipidemia, plaquetopenia de 102.000/µl e tomava aspirina, estava programada para endarterectomia aortoilíaca bilateral. A paciente foi submetida à anestesia geral e, no fim da cirurgia, a bloqueio do quadrado lombar tipo 1 bilateralmente para analgesia pós-operatória com 20 mL de ropivacaína a 0,5%, para cada lado, antes da extubação. Imediatamente após a internação na sala de recuperação pós-anestésica, a paciente evoluiu com hipotensão moderada (necessidade de infusão de dopamina durante 18 horas), concomitante à rápida redução dos escores de dor. Escore numérico para dor baixo e consumo de opioides foram observados, especialmente nas primeiras 24 horas de pós-operatório. Conclusões: O bloqueio do quadrado lombar foi uma técnica analgésica eficaz nesse caso de cirurgia aórtica aberta, embora a hipotensão associada ao bloqueio bilateral do quadrado lombar possa ocorrer. O bloqueio simpático associado, causado pelo bloqueio do QL tipo 1, provavelmente relacionado à extensão paravertebral bilateral do bloqueio, pode contribuir para a hipotensão pós-operatória associada à síndrome de isquemia-reperfusão em paciente submetido a pinçamento aórtico intraoperatório de longa duração. Alta concentração de anestésico local para prolongar a ação de uma injeção única no bloqueio do quadrado lombar, com o objetivo de evitar cateterização de ambas as anestesias peridural e do quadrado lombar bilateral, deve ser usada de modo criterioso.

Ultrasound guided quadratus lumborum block for analgesia after cesarean delivery: case series / Bloqueio do quadrado lombar guiado por ultrassom para analgesia pós cesariana: série de casos

Abstract Introduction: The majority of women having planned cesarean section receive spinal anesthesia for the procedure. Typically, spinal opioids are administered during the same time as a component of multimodal analgesia to provide pain relief in the 16-24 h period postoperatively. The quadratus lumborum block is a regional analgesic technique that blocks T5-L1 nerve branches and has an evolving role in postoperative analgesia for lower abdominal surgeries and may be a potential alternative to spinal opioids. If found effective, it will have the advantage of a reduction in opioid associated adverse effects while providing similar quality of analgesia. Methods: We performed bilateral quadratus lumborum block in 3 women who received a spinal anesthetic for a cesarean delivery and evaluated their post-operative opioid consumption and patient satisfaction. Results: In all 3 patients, there was no additional opioid consumption during the first 24 h after the block. Numeric Rating Scale (NRS) for pain was less than 6 for the first 24 h. Women were all very satisfied with the quality of pain relief. Discussion: Quadratus lumborum block may be a promising anesthetic adjuvant for post-cesarean analgesia. Further randomized controlled trials are needed to compare the efficacy of the quadratus lumborum block with intrathecal opioids.

Resumo Introdução: A maioria das mulheres agendadas para cesariana recebe anestesia raquidiana para o procedimento. Tipicamente, os opioides administrados por via espinhal (VE) são administrados ao mesmo tempo como um componente da analgesia multimodal para proporcionar alívio da dor no período pós-operatório de 16-24 horas. O bloqueio do quadrado lombar (QL) é uma técnica de analgesia regional que bloqueia os ramos nervosos T5- L1 e tem um papel crescente na analgesia pós-operatória de cirurgias abdominais inferiores, pode ser uma potencial opção para os opioides VE. Se for considerado eficaz, esse bloqueio terá a vantagem de uma redução nos efeitos adversos associados aos opioides e proporcionará qualidade semelhante de analgesia. Métodos: O bloqueio bilateral do quadrado lombar foi feito em três mulheres que receberam raquianestesia para parto cesário e o consumo de opioides no pós-operatório e a satisfação das pacientes foram avaliados. Resultados: Em todas as três pacientes, não houve consumo adicional de opioide durante as primeiras 24 horas após o bloqueio. A escala de avaliação numérica (EAN) para dor foi inferior a 6 durante as primeiras 24 horas. Todas as mulheres ficaram muito satisfeitas com a qualidade do alívio da dor. Discussão: O bloqueio do QL pode ser um adjuvante promissor para analgesia pós-cesariana. Estudos randomizados e controlados são necessários para comparar a eficácia do bloqueio do quadrado lombar com opioides administrados por via intratecal.

Comparison of ultrasound-guided quadratus lumborum block and transversus abdominis plane block com-bined with patient controlled intravenous analgesia with sufentanil on post-operation analgesia after ap-pendectomy / 临床麻醉学杂志

Objective To observe the difference of quadratus lumborum block (QLB)and transversus abdominis plane (TAP)block combined with patient controlled intravenous analgesia with sufentanil in analgesia after appendectomy.Methods Seventy-seven patients undergoing appendecto-my,including 44 patients males and 33 patients females,all falling into ASA Ⅰ or Ⅱ,were random-ized into group QLB (n =39)and group TAP block (n =38).Ultrasound-guided QLB and TAP block was performed at the end of operation and 0.25% ropivacaine hydrochloride 20 ml was used.Postop-erative VAS score and the consumption of sufentanil at 4,8,12,24 and 48 h was recorded.Postoper-ative nausea and vomiting,dizziness,skin itching were recorded.Results Patients in group QLB used significantly less sufentanil than that of group TAP (P <0.05 )at 12,24,48 h and VAS score has no differences after operation.Side effects like postoperative nausea and vomiting [2(5.1%)vs 8(21.0%)], and dizziness [4(10.2%)vs 11(28.9%)]were significantly less (P <0.05).Conclusion QLB can more effectively reduce postoperative sufentanil consumption and side effect than TAP block.

Evaluation on analgesic effect of ultrasound-guided quadrates lumborum block in patients undergoing rad-ical resection of rectal cancer / 临床麻醉学杂志

Objective To investigate the analgesia effects and duration ofultrasound-guided quadratus lumborum block (QLB)in radical resection of rectal cancer,and to evaluate its clinical effect, so as to provide new clinical ideas for intraoperative and postoperative analgesia. Methods Sixty patients who would undergo expected radical resection of transabdominal rectal cancer in our hospital from February,2016 to March,2017 were selected,of which 36 males and 24 fe-males,aged 30-70 years,ASA physical status Ⅰ or Ⅱ.They were randomly divided into two groups,30 cases in each.After induction,the patients in group QLB underwent ultrasound-guided bi-lateral QLB before surgury,40 ml of 0.375% ropivacaine was given to these patients.Patients in group C received general anesthesia alone.The values of systolic pressure (SBP),diastolic pressure (DBP),heart rate (HR)immediately before and 5 minutes after cutting were oberserved and recor-ded.The patients'incision reaction,the dosage of fentanyl intraoperative,the visual analogue scores (VAS)of 2,4,6,12,24,and 48 hours after operation,the first time pressing the analgesic pump button,the consumption of sufentanil,times of remedial analgesia,the time getting out of bed,the patient's satisfaction with postoperative analgesia were recorded in the two groups.Results The changes of SBP,DBP and HR 5 min before and after skin incision in group QLB were significantly lower than those in group C (P <0.05).The usage of fentanyl in group QLB significantly decreased compared with that in group C (P < 0.01 ).The first time pressing the analgesic pump button in group QLB was significantly later than that in group C (P <0.05).The usage of sufentanil signifi-cantly decreased in QLB group at 2,4,6,12 and 24 hours after operation compared with that in group C (P <0.05).The times of remedial analgesia in group QLB were lower than that in group C (P <0.05).The time getting out of bed and exhausting in group QLB were significantly earlier com-pared with those in group C (P <0.05).The patient's satisfaction with postoperative analgesia was significantly higher in group QLB compared with that in group C (P <0.05 ).Conclusion Bilateral quadratus lumborum blockage with 0.375% ropivacaine can reduce the opioid consumption for patients undergoing radical surgery of rectal cancer,and postoperative opioid usage was also reduced. The time getting out of the bed in group QLB was significantly shifted to an earlier date compared with those in group C.It can provide a satisfactory analgesia,and improve the patient's comfort and satisfaction.