艾司氯胺酮复合腰方肌阻滞多模式镇痛对剖宫产产妇术后慢性疼痛的影响

The Effect of Esketamine Combined with Quadratus Lumborum Block Multimodal Analgesia on Postoperative Chronic Pain in Cesarean Section Women

摘要: 目的：本研究旨在观察艾司氯胺酮复合超声引导腰方肌阻滞(Quadratus lumborum block, QLB)对剖宫产产妇术后慢性疼痛的影响，为临床提供参考。方法：选择我院90例拟在腰硬联合麻醉下行剖宫产产妇，年龄 ≥ 18岁，单胎妊娠 ≥ 36周，随机分为3组(n = 30例)：EQ组(艾司氯胺酮复合QLB)，E组(艾司氯胺酮)和Q组(QLB)。评估产妇术后1、3、6个月的慢性疼痛的发生率和疼痛强度，记录术后舒芬太尼和术后氢吗啡酮用量，记录术后48 h不良反应情况。结果：术后1个月和3个月，EQ组慢性疼痛的发生率分别低于E组和Q组(P < 0.05)，EQ组慢性疼痛强度也分别低于E组和Q组(P < 0.05)；EQ组术后48 h不良反应发生率分别低于E组和Q组(P < 0.05)。结论：艾司氯胺酮复合QLB可有效降低剖宫产产妇术后慢性疼痛的发生率和疼痛强度，减少术后镇痛药物用量，降低不良反应发生率，值得临床推广。

Abstract: Purpose: This study is to observe the effect of esketamine combined with ultrasound-guided quadratus lumbar muscle block (QLB) on postoperative chronic pain in cesarean section women, and provide reference for clinical practice. Method: Ninety parturients who were scheduled to undergo cesarean section under lumbar epidural anesthesia in our hospital, aged ≥ 18 years and with a singleton pregnancy of ≥ 36 weeks, were randomly divided into three groups (n = 30): EQ group (esketamine combined with QLB), E group (esketamine), and Q group (QLB). Evaluate the incidence and intensity of chronic pain in postpartum women at 1, 3, and 6 months after surgery, record the postoperative doses of sufentanil and hydromorphone, and record the adverse reactions at 48 hours after surgery. Results: At 1 and 3 months after surgery, the incidence of chronic pain in the EQ group was lower than that in the E and Q groups, respectively (P < 0.05), and the intensity of chronic pain in the EQ group was also lower than that in the E and Q groups, respectively (P < 0.05); The incidence of adverse reactions in the EQ group was lower than that in the E and Q groups 48 hours after surgery (P < 0.05). Conclusion: The combination of esketamine and QLB can effectively reduce the incidence and intensity of chronic pain in cesarean section women after surgery, reduce the dosage of postoperative analgesics, and lower the incidence of adverse reactions. It is worthy of clinical promotion.