背景：開腹手術(shù)中有效的局部鎮(zhèn)痛可以減少阿片類藥物的消耗，促進(jìn)早期康復(fù)。我們比較了腰方肌阻滯（QLB）和傳統(tǒng)的硬膜外阻滯（EB）在開腹子宮手術(shù)中的效果。

方法：在這項(xiàng)隨機(jī)對照試驗(yàn)中，我們納入了計(jì)劃于2019年5月至9月30日進(jìn)行擇期開腹子宮手術(shù)的患者?；颊咴谌砺樽砬敖邮?/span>QLB或EB用于圍手術(shù)期鎮(zhèn)痛。圍手術(shù)期阿片類藥物消耗量、術(shù)后疼痛評分（NRS:0-10）、心率（HR）、平均動(dòng)脈壓（MAP）、術(shù)中麻黃堿和烏拉地爾的使用、下肢肌肉力量、術(shù)后24小時(shí)內(nèi)第一次排氣和排便的時(shí)間、惡心、嘔吐和其他并發(fā)癥分別是主要和次要結(jié)果。

結(jié)果：對83例符合條件的患者中72例（86%；36/組）的數(shù)據(jù)進(jìn)行了分析。QLB組手術(shù)期間的瑞芬太尼消耗量高于EB組，而兩組術(shù)后24小時(shí)內(nèi)的累積舒芬太尼消耗量相似。術(shù)后1小時(shí)，QLB組靜息和活動(dòng)時(shí)的NRS疼痛評分較高，術(shù)后5、15和30分鐘的MAP高于EB組；各組之間的HR相似。QLB組術(shù)后1小時(shí)麻黃堿需求量較低，下肢肌肉力量較高，惡心發(fā)生率較低。

結(jié)論：與EB相比，QLB在開腹子宮手術(shù)后的前24小時(shí)產(chǎn)生的阻滯強(qiáng)度更小，但阻滯時(shí)間更長，副作用更少。

英文原文 

Comparison of the analgesic effect of quadratus lumborum block and epidural block in open uterine surgery: a randomized controlled trial

Abstract

Background:Effective regional analgesia during open surgery could reduce opioid consumption and enhance early recovery. We compared the effects of the newly developed quadratus lumborum block (QLB) and the traditional epidural block (EB) in open uterine surgery.

Method:In this randomized controlled trial, we included patients scheduled for elective open uterine surgery during May - September 30, 2019. Patients received QLB or EB for perioperative pain relief before general anesthesia. Perioperative opioid consumption, and numeric rating scale (NRS: 0-10) pain scores after surgery, heart rate (HR), mean arterial pressure (MAP), ephedrine and urapidil use during surgery, lower limb muscle strength, timing of first flatus and defecation, nausea, vomiting, and other complications within 24 h post-surgery, were the primary and secondary outcomes, respectively.

Results:Data of 72 (86%; 36/group) of 83 eligible patients were analyzed. Remifentanil consumption during surgery was higher in the QLB than in the EB group, while cumulative sufentanil consumption within 24 h post-surgery was similar between both groups. NRS pain scores at rest and during activity were higher at 1 h post-surgery, and MAP was higher at 5-, 15-, and 30-min postincision in the QLB than in the EB group; HR was similar between groups. Lower ephedrine requirements, higher lower limb muscle strength at 1 h post-surgery, and lower nausea incidence were observed in the QLB group.

Conclusion:QLB produces a less intense but longer block and fewer side effects in the first 24 h after open uterine surgery than those produced by EB.