超声引导下弓状韧带上腰方肌阻滞与腹横肌平面阻滞在腹腔镜下结直肠癌根治术术后镇痛效果的比较

Comparison of Analgesic Efficacy between Arcuate Ligament Lumbar Quadratus Muscle Block and Transverse Abdominis Plane Block under Ultrasound Guidance after Laparoscopic Radical Resection of Colorectal Cancer

摘要: 目的：比较超声引导下弓状韧带上传导至腰方肌阻滞(QLB)与腹横肌平面阻滞(TAPB)在腹腔镜行结直肠癌根治术后的镇痛作用。方法：选取2024年1月至2025年02月义乌市中心医院收治的行腹腔镜下结直肠癌根治手术治疗患者60例，按随机数字表法将其分成两组。即超声引导下腹横肌平面阻滞组(T组，n = 30)以及超声引导下弓状韧带上腰方肌阻滞组(Q组，n = 30)。在麻醉诱导开始之前，T组实施双侧超声引导下腹横肌平面阻滞(TAPB)，每一侧给予0.375%罗哌卡因20 ml，而Q组则开展双侧超声引导下弓状韧带上腰方肌阻滞(QLB)，同样每一侧给予0.375%罗哌卡因20 ml。随后在气管插管全身麻醉状态下完成手术操作，术后两组都实行患者自控静脉镇痛(PCIA)。比较两组患者在手术后的6 h内、24 h内及48 h内处于安静状态下与活动时所出现的VAS疼痛评分情况，并且还需要将该时间段内有补救性止疼需求的病患人数也做相应的比较分析。结果：Q组术后6小时、24小时、48小时静息时及活动时的VAS评分均明显低于T组，P < 0.05，存在统计学意义上的显著差异。在术后48 h内需补救性止痛患者例数上，Q组较T组更少(P < 0.05)，具有统计学意义。结论：超声引导下弓状韧带上腰方肌阻滞能够为腹腔镜结直肠癌患者带来更为理想的术后镇痛效果，具备推广与应用的价值。

Abstract: Objective: To compare the analgesic effects of ultrasound-guided quadratus lumborum block via the ligamentum arch (QLB) versus transverse abdominis plane block (TAPB) after laparoscopic radical resection of colorectal cancer. Methods: A total of 60 patients undergoing laparoscopic radical resection for colorectal cancer admitted to Yiwu Central Hospital from January 2024 to February 2025 were randomly divided into two groups using a random number table: the ultrasound-guided transverse abdominis plane block group (T group, n = 30) and the ultrasound-guided quadratus lumborum block via the ligamentum arch group (Q group, n = 30). Prior to anesthesia induction, the T group received bilateral ultrasound-guided transverse abdominis plane block (TAPB), with 20 mL of 0.375% ropivacaine administered per side, while the Q group underwent bilateral ultrasound-guided quadratus lumborum block via the ligamentum arch (QLB), also with 20 mL of 0.375% ropivacaine per side. Surgical procedures were performed under general anesthesia with endotracheal intubation, followed by patient-controlled intravenous analgesia (PCIA) in both groups postoperatively. VAS pain scores at rest and during activity were compared between the two groups at 6 hours, 24 hours, and 48 hours postoperatively, along with analysis of the number of patients requiring rescue analgesia during these time periods. Results: The VAS scores at rest and during activity in the Q group were significantly lower than those in the T group at all time points (6 hours, 24 hours, 48 hours; P < 0.05), indicating statistically significant differences. The number of patients requiring remedial analgesia within 48 hours postoperatively was significantly lower in Group Q compared to Group T (P < 0.05), demonstrating statistical significance.