COMPARISON OF LUMBAR SQUARE MUSCLE BLOCK AND TRANSVERSUS ABDOMINIS PLANE BLOCK IN RAPID POSTOPERATIVE REHABILITATION AFTER GYNECOLOGICAL LAPAROSCOPIC SURGERY

Huanhuan Luo, Xiaofeng Lin, Xin Guo, Anling Sun, Dexing Luo^*, Wenya Chen 

Department of Anesthesiology, Huizhou Municipal Central Hospital, Huizhou, Guangdong, 516001, China

Objective: To compare the efficacy of ultrasound guided Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) in gynecological laparoscopic surgery combined with general anesthesia for rapid postoperative recovery of patients. 

Methods: Eighty patients undergoing elective gynecological laparoscopic surgery under general anesthesia from January 2019 to January 2020 in our hospital, ASA class I-III, aged 18-65 years, were selected, and all patients voluntarily accepted this trial and signed the relevant informed consent forms, and all passed the ethics committee of our hospital. The patients were randomly divided into 2 groups of 40 cases each, the lumbar square muscle block group (Group Q) and the transversus abdominis plane block group (Group T), respectively. After admission, the subjects in both groups underwent ultrasound-guided lumbar square block or ultrasound-guided transversus abdominis plane block (20 ml of 0.375% ropivacaine bilaterally, 40 ml in total) according to the group. Patient Controlled Intravenous Analgesia (PCIA) was administered at the end of surgery. Real-time data such as Mean Arterial Pressure (MAP) and Heart Rate (HR) were recorded at each time of patient entrance (T0), immediately before skin incision (T1), 1 minute after skin incision (T2), 5 minutes after skin incision (T3), and end of operation (T4), and the correlation between the data at different time points was calculated. The total duration of surgical anesthesia was recorded; the intraoperative use of various types of anesthetic drugs was counted; the postanesthesia care unit (PACU) stay and the total time of tracheal tube removal were recorded; the total duration of intravenous anesthesia at each time (2h, 4h, 8h, 24h, 48h after surgery, i.e., T5, T6, T7, T8, T9) was recorded. Total cortisol concentrations in the serum of patients in both groups were recorded before and 8h(T7), 24h(T8) and 48h(T9) after surgery; The total amount of postoperative sufentanil used, the time of first analgesic pump pressure and the total number of pressure; the time of anal venting, the time of first bed activity, the postoperative satisfaction score, the postoperative additional analgesia and the incidence of postoperative adverse effects were recorded. Postoperative discharge time of patients were recorded. 

Results: The amount of sufentanil supplementation in group Q was significantly less than that in group T (P<0.05).ΔMBPT2-T1, ΔHRT2-T1, ΔMBPT3-T1, ΔHRT3-T1 in group Q are much smaller than group T (P<0.05).The resting and motor VAS scores of group Q at 2h, 4h, 8h, 24h and 48h after surgery were significantly lower than those of group T (P<0.05). The postoperative serum total cortisol concentrations increased to some extent at all times in both groups, and the increase in cortisol concentrations was smaller in patients in group Q compared with group T (P<0.05). The first postoperative anal exhaust time, the first time of getting out of bed and the time of feeding in group Q were shorter than those in group T (P<0.05).The postoperative satisfaction of group Q was better than that of group T (P<0.05).

Conclusion: Compared with transversus abdominis plane block, ultrasound-guided lumbar square muscle block can reduce the amount of perioperative opioids in patients undergoing gynecological laparoscopy, better maintain intraoperative hemodynamic stability, and more always cortisol hormone secretion, reduce the degree of stress response of the body, shorten the time to first anal venting, time to first bed activity, and time to have food after surgery, and accelerate the turnaround, which is more conducive to rapid postoperative recovery of patients undergoing gynecological laparoscopy. The application of general anesthesia combined with ultrasound-guided lumbar square muscle nerve block in gynecological laparoscopic surgery is worth promoting in clinical work.