Effect of Ultrasound-guided Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Pediatric Patient Undergoing Hip Surgery
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摘要:
目的 评价超声引导下前路腰方肌阻滞对髋关节手术患儿术后镇痛的效果。 方法 择期髋部手术患儿60例，年龄1～3岁，ASAⅠ～Ⅱ，麻醉诱导气管插管后随机分为2组。TQL组（0.2%罗哌卡因0.5 mL/kg前路腰方肌阻滞组，n = 30），C组（不行腰方肌阻滞，n = 30）。主要观察指标为记录术后24 h内需要补救镇痛药的需求情况；次要指标为术后1 h、4 h、6 h、12 h和24 h 的FLACC评分、心率、血压，以及术后不良事件（如局部血肿、脏器损伤）。 结果 术后24 h C组的补救镇痛药需求显著增加[21/30（70%） vs 5/30（16.7%），P < 0.001]；与C组相比较，TQL组术后24 h不同观察时点FLACC评分、心率、血压均较低（P < 0.05）。TQL组无1例患儿发生术后不良反应。 结论 超声引导下腰方肌阻滞可降低髋关节手术患儿术后疼痛评分，减少镇痛药物需求。 Abstract:Objective To evaluate the analgesic effect of ultrasound-guided transmuscular quadratus lumborum block in pediatric patients for hip surgery. Methods 60 children with elective hip operation, aged 1-3 years, ASAⅠ～Ⅱ, were randomly divided into 2 groups after anesthesia induction tracheal intubation. The patients of TQL group （n = 30） received ultrasound-guided transmuscular quadratus lumborum block, while the patients of group C （n = 30） did not receive TQL block. The primary outcome was the number of patients who require rescue analgesia in the first 24 h. The secondary outcome were the FLACC pain scale, heart rate, and blood pressure at 1 h, 4 h, 6 h, 12 h and 24 h postoperatively, and postoperative adverse event （e.g., local hematoma, and organ injuries）. Results 24 h after surgery, the need for rescue analgesia was statistically significantly higher in group C when compared to the TQL group [21/30 （70%） vs 5/30 （16.7%）, P < 0.001]. The FLACC score, heart rate, and blood pressure were lower in the TQL group than the C group at various points during 24 h postoperatively （P < 0.05）. No postoperative adverse event occurred in the TQL group. Conclusion Ultrasound-guided quadratus lumborum block reduces pain scores and analgesic needs following hip surgery in pediatric patients. -
表 1 2组患儿人员结构比及术中资料比较 （
$ \bar x \pm s$ ）Table 1. Comparison of Demographic data and the data of during operation between two groups （
$ \bar x \pm s$ ）项目 TQL组 C组 效应值 P 男/女 （n） 4/26 5/25 0.131 0.718 体重 （kg） 11.3 ± 1.7 10.9 ± 1.6 0.102 0.275 年龄（岁） 2.4 ± 0.7 2.3 ± 0.5 0.794 0.430 ASA分级（Ⅰ/Ⅱ） 8/ 22 10/ 20 0.317 0.573 手术时间（min） 161 ± 11.1 153 ± 9.9 1.025 0.288 入量（mL/kg·h） 16.1 ± 2.3 15.6 ± 2.2 1.632 0.109 失血量（mL） 179.3 ± 20.3 170.1 ± 17.1 1.888 0.064 丙泊酚用量（mg/kg·h） 4.6 ± 0.6 4.5 ± 0.5 0.219 0.827 瑞芬太尼用量（μg/kg·min） 0.14 ± 0.02 0.15 ± 0.03 −1.545 0.128 拔管时间（min） 24.7 ± 4.6 25.8 ± 4.1 −1 .392 0.168 
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表 2 2组患儿术后镇痛药使用率比较 [n（%）]
Table 2. Comparison of the incidence of analgesia between two groups [n（%）]
指标 TQL组 C组 χ2 P 病房前24 h补救药使用率 5 （16.7） 21 （70） −17.38 < 0.001* 与C组比较，*P < 0.05。
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表 3 2组患儿术后ALACC疼痛评分比较 [（
$ \bar x \pm s$ ），分]Table 3. Comparison of FLACC scores between two groups[ [（
$ \bar x \pm s$ ），scores]组别 1 h 6 h 12 h 24 h TQL组 1.53 ± 0.57 1.67 ± 0.61 1.80 ± 0.55 3.20 ± 0.61 C组 3.27 ± 0.64 4.20 ± 0.55 4.10 ± 0.48 4.07 ± 0.45 t −17.64 −25.39 −17.23 −6.26 P < 0.001* < 0.001 * < 0.001* < 0.001 * 与C组比较，*P < 0.05。
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表 4 2组患儿术后心率和平均动脉压比较 （
$ \bar x \pm s$ ）Table 4. Comparison of the postoperative HR and MAP between two groups （
$ \bar x \pm s$ ）指标 组别 1 h 6 h 12 h 24 h HR （次/min） TQL组 85.50 ± 7.93 86.47 ± 7.04 87.43 ± 5.64 85.07 ± 5.56 C组 95.97 ± 7.65 98.77 ± 5.46 97.83 ± 7.46 87.536 ± 6.61 t −5.205 −7.554 −6.087 −1.564 P < 0.001* < 0.001* < 0.001* 0.123 MAP （mmHg） TQL组 63.07 ± 4.80 65.57 ± 3.38 65.43 ± 3.18 67.03 ± 3.92 C组 71.23 ± 3.79 73.20 ± 2.58 72.832 ± 3.16 70.10 ± 4.02 t −7.31 −9.93 −9.45 −3.38 P < 0.001* < 0.001* < 0.001* 0.001* 与C组比较，*P < 0.05。
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