【罂粟摘要】三种腰方肌阻滞入路用于小儿下腹部手术的效果比较：一项随机对照试验

三种腰方肌阻滞入路用于小儿下腹部手术的效果比较：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：王波编辑：王波审校：曹莹

背景

背景jbhb

小儿下腹部手术常伴有显著的术后疼痛。目前已探索了包括髂腹股沟神经阻滞、腹横肌平面（TAP）阻滞和腰方肌（QL）阻滞在内的多种区域麻醉技术用于此类手术的镇痛。本研究旨在比较三种不同入路腰方肌阻滞用于小儿下腹部手术的镇痛效果。

方法

本随机对照试验纳入120 例年龄 1 至 7 岁、拟在全身麻醉下行择期下腹部手术的患儿。患者被随机分为 3 组：A 组接受前路 QL 阻滞，L 组接受侧路 QL 阻滞，P 组接受后路 QL 阻滞。所有患者均单侧注射 0.5 mL/kg 的 0.375% 罗哌卡因。主要结局指标为术后 24 小时芬太尼消耗量。次要结局指标包括术中芬太尼用量、术后疼痛评分、首次补救镇痛时间以及家长满意度。

结果

A 组术后平均芬太尼消耗量显著低于 L 组（p < 0.001）和 P 组（p < 0.011）。在术后早期，A 组的 FLACC 评分中位数显著低于 L 组和 P 组（p < 0.05）。A 组的家长满意度评分显著更高（p < 0.05）。

讨论

对于接受下腹部手术的患儿，与侧路和后路相比，前路腰方肌阻滞能减少术后镇痛药物的消耗，提供更长时间的镇痛效果，并获得更高的家长满意度。

原始文献来源：Sk A, Kumar A, Kumar A, Sinha C, Kumar A, Kumari P, Kumar B. Comparison of three quadratus lumborum block approaches for pediatric lower abdominal surgeries: a randomized controlled trial. Braz J Anesthesiol. 2025 Nov-Dec;75(6):844683. doi: 10.1016/j.bjane.2025.844683. Epub 2025 Sep 11. PMID: 40945654; PMCID: PMC12557593.

Comparison of three quadratus lumborum block approaches for pediatric lower abdominal surgeries: a randomized controlled trial

Background: Lower abdominal surgeries in the pediatric population are associated with significant post-operative pain. Regional anesthesia techniques including ilioinguinal nerve block, Transversus Abdominis Plane (TAP) block, and Quadratus Lumborum (QL) block have been explored for lower abdominal surgeries. This study compares the analgesic effect of three different approaches to quadratus lumborum block in pediatric patients undergoing lower abdominal surgeries.

Methods: This randomized controlled trial included 120 pediatric patients aged between 1 and 7 years, scheduled for lower abdominal surgery under general anesthesia. Patients were randomized into 3 groups. Patients of Group A received QL block via anterior approach, Group L received QL block via lateral approach, and Group P received QL block via posterior approach. A volume of 0.5 mL.kg-1 of 0.375% ropivacaine was injected unilaterally for QL block in all patients. The primary outcome was 24hr postoperative fentanyl consumption. Secondary outcomes included intraoperative fentanyl use, postoperative pain scores, time to rescue analgesia and parental satisfaction.

Results: Postoperative mean fentanyl consumption was significantly lower in Group A as compared to Group L (p < 0.001) and Group P (p < 0.011). Postoperative median FLACC scores were significantly lower (p < 0.05) in Group A in comparison to Group L and Group P in the early postoperative period. The parent satisfaction score was significantly higher (p < 0.05) in Group A.

Conclusion: Anterior approach to QL block reduces postoperative analgesic consumption and provides longer duration analgesia with better parental satisfaction scores in comparison to lateral and posterior approaches in pediatric patients undergoing lower abdominal surgeries.

END