关注罂粟花，共同学习麻醉学最新文献
竖脊肌平面和腰方肌阻滞治疗全腹子宫切除术术后疼痛的比较疗效：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：田明德 编辑：赵游霄 审校：曹莹
有效的腹部全子宫切除术后疼痛管理是患者康复和满意度的关键。本研究比较了竖脊肌平面阻滞（ESPB）和腰方肌阻滞（QLB）在减少全腹子宫切除术患者术后阿片类药物消耗和疼痛方面的疗效。
在这项前瞻性、随机对照试验中，90例接受腹式全子宫切除术的患者被分为3组：ESPB组、QLB组和对照组。主要结局是术后阿片类药物的消耗。次要结局包括在预定时间用视觉模拟量表评估疼痛评分和术后恶心和呕吐的发生率。采用方差分析、Mann-Whitney U检验和Kruskal-Wallis检验确定统计显著性。
与对照组相比，ESPB组和QLB组术后阿片类药物消耗显著减少（两组比较均P < 0.001）。ESPB组和QLB组术后2、6、24小时疼痛评分均显著低于对照组（P < 0.001）。ESPB组和QLB组术后恶心呕吐发生率均低于对照组；但差异无统计学意义（P = 0.029）。两组患者的阿片类药物消耗和疼痛评分均无显著差异
竖脊肌平面和腰方肌阻滞均能有效减少全腹子宫切除术患者术后阿片类药物的消耗和疼痛。这些技术为术后疼痛管理提供了一种很有前途的方法，有可能减少对阿片类药物的需求。
原始文献：
Baran, O., Şahin, A., & Arar, C. (2024). Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial. Medicine, 103(43), e40313.
英文原文：
Comparative efficacy of erector spinae plane and quadratus lumborum blocks in managing postoperative pain for total abdominal hysterectomy: A randomized controlled trial
Abstract
Background: Effective postoperative pain management after total abdominal hysterectomy is crucial for patient recovery and satisfaction. This study compared the efficacy of the erector spinae plane block (ESPB) and quadratus lumborum block (QLB) in reducing postoperative opioid consumption and pain in patients with total abdominal hysterectomy.
Method:In this prospective, randomized controlled trial, 90 patients undergoing total abdominal hysterectomy were divided into 3 groups: ESPB, QLB, and control. The primary outcome was postoperative opioid consumption. Secondary outcomes included pain scores assessed by the visual analog scale at predetermined times and the incidence of postoperative nausea and vomiting. Statistical significance was determined using analysis of variance, the Mann-Whitney U test, and the Kruskal-Wallis test.
Results:The ESPB and QLB groups showed a significant reduction in postoperative opioid consumption compared with the control group (P < .001 for both comparisons). Pain scores were significantly lower in the ESPB and QLB groups than in the control group at 2, 6, and 24 hours postoperatively (P < .001 at each time point). The incidence of postoperative nausea and vomiting was lower in the ESPB and QLB groups than that in the control group; however, this difference was not statistically significant (P = .029). No significant differences were observed in opioid consumption or pain scores between the 2 groups.
Conclusion:Both the erector spinae plane and quadratus lumborum blocks effectively reduced postoperative opioid consumption and pain in patients with total abdominal hysterectomy. These techniques offer a promising approach for postoperative pain management, potentially reducing the need for opioids.
END
