关键词: 弓状韧带上腰方肌阻滞, 竖脊肌阻滞, 术后早期康复, 后路腰椎手术

Abstract:

Objective To compare the effects of quadratus lumborum block at the lateral supra?arcuate ligament （QLB?LSAL） and erector spinae plane block （ESPB） on early postoperative recovery in patients undergoing posterior lumbar surgery. Methods Ninety?three patients， aged 25 ~ 70 years， BMI 18 ~ 30 kg/m2 and ASA physical status Ⅱ or Ⅲ and scheduled for posterior lumbar surgery， were randomly divided into QLB?LSAL combined with general anesthesia （Group Q）， ESPB combined with general anesthesia （Group E）， and general anesthesia alone （Group N）. Postoperatively， all groups received patient?controlled intravenous analgesia （PCIA）. The following parameters were recorded： the scores of Richmond Agitation?Sedation Scale （RASS） and Bergman Comfort Scale （BCS） at awakening， 6 h， 12 h， and 24 h postoperatively； Likert scale score at PCIA cessation； the scores of Pittsburgh Sleep Quality Index （PSQI） and Early Postoperative Quality of Recovery?15 （QoR?15） at 1 day preoperatively and 1 day and 3 days postoperatively. Additionally， postoperative recovery indicators including awakening time， extubation time， PACU stay time， time to first anal exhaust， time to first ambulation， postoperative hospital stay， and adverse reactions within 48 h were recorded. Results （1）Compared with group N， group Q showed significantly lower RASS scores and higher BCS scores at all postoperative time points， with a higher proportion of Likert score grade 1 after PCIA cessation （P < 0.05）. Group E had lower RASS scores at emergence and 24 h postoperatively， and higher BCS scores at emergence， 6 h， and 24 h postoperatively while compared to group N （P < 0.05）. At 12h postoperatively， group Q demonstrated lower RASS scores and higher BCS scores than group E （P < 0.05）. （2） Compared with Group N， group Q exhibited lower PSQI scores and higher QoR?15 scores at 1 and 3 days postoperatively （P < 0.05）. No statistically significant difference in PSQI scores was observed between group E and N （P > 0.05）， while group E had higher QoR?15 score than group N only at 1 day postoperatively （P < 0.05）. Both at 1 and 3 days postoperatively， group Q had lower PSQI scores and higher QoR?15 scores than group E （P < 0.05）. （3） Postoperative awakening time， extubation time， PACU stay time， time to first anal exhaust and time to first ambulation were significantly shorter in group Q than those in group N （P < 0.05）. Group E only showed shorter time to first anal exhaust compared to group N （P < 0.05）. Furthermore， group Q had a significantly shorter PACU stay time than group E （P < 0.01）. （4） There was no statistically significant difference in the incidence of adverse reactions among the three groups of patients. （P > 0.05）. Conclusions Both QLB?LSAL and ESPB effectively improve postoperative analgesia and early recovery quality. However， QLB?LSAL demonstrates advantages in enhancing patient comfort， analgesia satisfaction， sleep quality， and accelerating overall postoperative recovery.

Key words: quadratus lumborum block at the lateral supra-arcuate ligament, erector spinae plane block, early postoperative recovery, posterior lumbar surgery