弓状韧带上腰方肌阻滞对机器人辅助前列腺癌根治术老年患者术后镇痛及炎症反应的影响

doi:10.3969/j.issn.1006-5725.2024.02.013

Abstract

Abstract:

Objective To investigate the effect of ultrasound?guided anterior quadratus lumborum block at lateral supra?arcuate ligament on postoperative analgesia and inflammation response in elderly patients undergoing robot?assisted laparoscopic radical prostatectomy. Methods A total of 60 elderly patients who had undergone robot?assisted laparoscopic radical prostatectomy from June 2022 to June 2023 were randomly divided into a group of ultrasound?guided anterior quadratus lumborum block at lateral supra?arcuate ligament combined with general anesthesia （observation group， n = 30） and a general anesthesia group （control group， n = 30）. Both groups received patient?controlled intravenous analgesia after surgery. The first compression time of an analgesic pump and the numbers of effective compression and remedial analgesia were recorded. The VAS scores at postsurgical hours 2， 12， 24， and 48 during rest and coughing were recorded. Interleukin?6 （IL?6） and systemic immunoinflammatory index （SII） at one day before surgery and two hours， one day and three days after surgery were recorded. Anal exhaust time， length of postoperative hospital stay and occurrence of adverse reactions were recorded. Results The observation group， as compared with the control group， had significantly longer first compression time of an analgesic pump and had fewer numbers of effective compressions and remedial analgesic administrations （P < 0.05）. The VAS scores during rest and coughing in the observation group were lower than those in the control group at postsurgical hours 2， 12， 24， and 48（P < 0.05）. As compared with one day before surgery， both IL?6 and SII in the two groups increased at 2 hours， 1， and 3 days after surgery， but the changes in the observation group were lower than those in the control group （P < 0.05）. As compared with the control group， the observation group had shorter anal exhaust time and length of postoperative hospital stay， and a lower incidence of adverse reactions （P < 0.05）. Conclusions Ultrasound?guided anterior quadratus lumborum block at lateral supra?arcuate ligament can provide better postoperative analgesia， reduce inflammatory response and accelerate postoperative recovery in elderly patients undergoing robot?assisted laparoscopic radical prostatectomy.

Key words: arcuate ligament, quadratus lumborum block, radical prostatectomy, elderly patients, postoperative analgesia, inflammation response

CLC Number:

R614

Guojiang YIN,Bixi LI,Pengxiao WEI,Yuqin YAN,Xiaoyang SONG,Kun LI. Effect of anterior quadratus lumborum block at the lateral supra⁃arcuate ligament on postoperative analgesia and inflammatory response in elderly patients undergoing robot⁃assisted radical prostatectomy[J]. The Journal of Practical Medicine, 2024, 40(2): 202-206.

Figures/Tables 7

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References 20

1	SIEGEL R L， MILLER K D， WAGLE N S， et al. Cancer statistics， 2023［J］. CA Cancer J Clin， 2023， 73（1）：17-48. doi:10.3322/caac.21763 doi: 10.3322/caac.21763
2	MA J， XU W， CHEN R， et al. Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer： the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies［J］. Int J Surg， 2023， 109（5）：1350-1359. doi:10.1097/js9.0000000000000193 doi: 10.1097/js9.0000000000000193
3	王东，郭剑明，古迪，等. 单孔机器人辅助前列腺癌根治术专家共识［J］. 微创泌尿外科杂志， 2023， 12（1）：18-24.
4	王星，靳通通，吴王剑，等. 机器人辅助腹腔镜前列腺癌根治术后性功能恢复的研究进展［J］. 机器人外科学杂志（中英文）， 2022， 3（3）：194-200.
5	WOLDU S L， WEINBERG A C， BERGMAN A， et al. Pain and analgesic use after robot-assisted radical prostatectomy［J］. J Endourol， 2014， 28（5）：544-548. doi:10.1089/end.2013.0783 doi: 10.1089/end.2013.0783
6	KNIPPER S， HAGEDORN M， SADAT-KHONSARI M， et al. Comparison of intra- and postoperative analgesia and pain perception in robot-assisted vs. open radical prostatectomy［J］. World J Urol， 2020， 38（6）：1451-1457. doi:10.1007/s00345-019-02938-w doi: 10.1007/s00345-019-02938-w
7	殷国江，李月，阮剑辉，等. 超声引导椎旁阻滞在机器人辅助肾切除手术中的应用［J］. 实用医学杂志， 2022， 38（2）：196-200. doi:10.3969/j.issn.1006⁃5725.2022.02.013 doi: 10.3969/j.issn.1006?5725.2022.02.013
8	阳婷婷，宋珂珂，汪博，等. 超声引导下弓状韧带上腰方肌阻滞对老年肾癌根治术后疼痛及早期康复的影响［J］. 实用医学杂志， 2022， 38（6）：779-782. doi:10.3969/j.issn.1006-5725.2022.06.025 doi: 10.3969/j.issn.1006-5725.2022.06.025
9	LI H， SHI R， WANG Y. A Modified Approach Below the Lateral Arcuate Ligament to Facilitate the Subcostal Anterior Quadratus Lumborum Block［J］. J Pain Res， 2021， 14：961-967. doi:10.2147/jpr.s306696 doi: 10.2147/jpr.s306696
10	SHI R， LI H， WANG Y. Dermatomal coverage of single-injection ultrasound-guided parasagittal approach to anterior quadratus lumborum block at the lateral supra-arcuate ligament［J］. J Anesth， 2021， 35（2）：307-310. doi:10.1007/s00540-021-02903-1 doi: 10.1007/s00540-021-02903-1
11	HANSEN C， DAM M， NIELSEN M V， et al. Transmuscular quadratus lumborum block for total laparoscopic hysterectomy： a double-blind， randomized， placebo-controlled trial［J］. Reg Anesth Pain Med， 2021， 46（1）：25-30. doi:10.1136/rapm-2020-101931 doi: 10.1136/rapm-2020-101931
12	DAM M， HANSEN C， POULSEN TD， et al. Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy［J］. Reg Anesth Pain Med， 2021， 46（1）：18-24. doi:10.1136/rapm-2020-101745 doi: 10.1136/rapm-2020-101745
13	HU Z， ZHOU Y， ZHAO G， et al. Effects of quadratus lumborum block on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy［J］. BMC Anesthesiol， 2022， 22（1）：213. doi:10.1186/s12871-022-01755-w doi: 10.1186/s12871-022-01755-w
14	蔡敏，尹泓，易明亮，等. 超声引导下经弓状韧带上或前路腰方肌阻滞在腹腔镜全子宫切除术中的比较［J］. 临床麻醉学杂志， 2022， 38（3）：229-233. doi:10.12089/jca.2022.03.001 doi: 10.12089/jca.2022.03.001
15	LI H， LIANG J， SHAO P， et al. Supra-Arcuate Ligament Blocks： Anatomy， Mechanisms， and Techniques［J］. J Pain Res， 2021， 14：3837-3848. doi:10.2147/jpr.s347071 doi: 10.2147/jpr.s347071
16	阳婷婷，宋珂珂，汪博，等. 超声引导下双侧弓状韧带上腰方肌阻滞在宫颈癌根治术患者术后镇痛的效果［J］. 临床麻醉学杂志， 2022， 38（3）：265-269. doi:10.12089/jca.2022.03.009 doi: 10.12089/jca.2022.03.009
17	JIN J， ZHANG T， XIONG X， et al. A prospective study of chronic postsurgical pain in elderly patients： incidence， characteristics and risk factors［J］. BMC Geriatr， 2023， 23（1）：289. doi:10.1186/s12877-023-04006-w doi: 10.1186/s12877-023-04006-w
18	AL-MAZIDI S， FARHAT K， NEDJADI T， et al. Association of Interleukin-6 and Other Cytokines with Self-Reported Pain in Prostate Cancer Patients Receiving Chemotherapy ［J］. Pain Med， 2018， 19（5）：1058-1066. doi:10.1093/pm/pnx145 doi: 10.1093/pm/pnx145
19	李秋月，许海玉，杨洪军. 促炎因子TNF-Α， IL-1Β， IL-6在神经病理性疼痛中的研究进展［J］. 中国中药杂志， 2017， 42（19）：3709-3712.
20	MENG L， YANG Y， HU X， et al. Prognostic value of the pretreatment systemic immune-inflammation index in patients with prostate cancer： a systematic review and meta-analysis［J］. J Transl Med， 2023， 21（1）：79. doi:10.1186/s12967-023-03924-y doi: 10.1186/s12967-023-03924-y

指标	观察组（n = 30）	对照组（n = 30）	χ²/t值	P值
ASA（例）			0.23	0.89
Ⅰ级	2	3
Ⅱ级	20	19
Ⅲ级	8	8
年龄（岁）	70.17 ± 5.40	70.03 ± 5.65	0.09	0.93
体质量（kg）	67.17 ± 7.71	68.23 ± 6.36	-0.59	0.56
身高（cm）	169.27 ± 6.65	169.53 ± 5.60	-0.17	0.87
BMI（kg/m²）	23.39 ± 1.64	23.76 ± 2.18	-0.75	0.46
手术时间（min）	220.10 ± 26.93	218.13 ± 26.18	0.29	0.78
晶体输入量（mL）	1251.67 ± 263.43	1248.33 ± 265.06	0.05	0.96
胶体输入量（mL）	688.33 ± 185.55	698.33 ± 175.42	-0.22	0.83
出血量（mL）	126.33 ± 50.68	125.67 ± 47.83	0.05	0.96
尿量（mL）	518.33 ± 181.70	521.67 ± 181.79	-0.07	0.94

组别	例数	有效按压	补救镇痛
观察组	30	1.50（0.75，3.00）	0.00（0.00，0.00）
对照组	30	3.00（2.00，5.00）	0.00（0.00，1.00）
Z值		-2.85	-2.32
P值		< 0.01	0.02

指标	分组	例数	术后2 h	术后12 h	术后24 h	术后48 h
静息VAS	观察组	30	1.50（0.00，2.00）	2.00（0.75，3.00）	2.00（2.00，3.00）	2.00（1.00，2.00）
	对照组	30	3.00（2.00，3.00）	3.00（2.00，3.00）	3.00（2.00，3.00）	2.00（2.00，3.00）
	Z值		-3.54	-3.13	-3.29	-2.72
	P值		< 0.01	< 0.01	< 0.01	< 0.01
咳嗽VAS	观察组	30	2.50（0.75，3.00）	3.00（2.00，4.00）	3.00（2.00，3.00）	2.00（2.00，3.00）
	对照组	30	3.00（3.00，4.00）	4.00（3.00，4.00）	4.00（3.00，4.00）	3.00（2.00，3.00）
	Z值		-4.16	-2.30	-4.29	-2.69
	P值		< 0.01	< 0.01	< 0.01	< 0.01

指标	分组	例数	术前1 d	术后2 h	术后1 d	术后3 d
IL-6（pg/mL）	观察组	30	3.68 ± 1.49	41.46 ± 20.95^?#	75.26 ± 37.75^?#	48.78 ± 24.97^?#
	对照组	30	3.67 ± 1.51	60.53 ± 29.01^?	113.67 ± 59.38^?	71.97 ± 34.43^?
	F_时间/P_时间		164.23/< 0.01
	F_{时间组间}/P_{时间组间}		7.32/< 0.01
	F_组间/P_组间		9.82/< 0.01
SII（× 10⁹/L）	观察组	30	433.81 ± 205.93	1 803.43 ± 1 000.99^?#	1 321.83 ± 718.47^?#	955.01 ± 505.95^?#
	对照组	30	432.88 ± 209.20	2 578.67 ± 1 398.89^?	2 181.56 ± 1 048.04^?	1 503.09 ± 793.35^?
	F_时间/P_时间		82.03/< 0.01
	F_{时间组间}/P_{时间组间}		5.39/< 0.01
	F_组间/P_组间		11.75/< 0.01

组别	例数	肛门排气时间（d）	术后住院时间（d）	不良反应［例（%）］
观察组	30	1.00（1.00，2.00）	9.00（8.00，10.25）	2（6.67）
对照组	30	2.00（2.00，3.00）	12.50（9.75，13.25）	8（26.67）
Z/χ²值		-4.19	-3.95	4.32
P值		< 0.01	< 0.01	0.04

Effect of anterior quadratus lumborum block at the lateral supra⁃arcuate ligament on postoperative analgesia and inflammatory response in elderly patients undergoing robot⁃assisted radical prostatectomy

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