对乙酰氨基酚甘露醇注射液联合腰方肌阻滞用于妇科腹腔镜术后镇痛的效果观察

Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injectioncombined with quadratus lumborum block after gynaecological laparoscopy

摘要:

目的 观察对乙酰氨基酚甘露醇注射液联合腰方肌阻滞（QLB）用于妇科腹腔镜手术术后多模式镇痛 的效果。方法 选取2024年1-6月在深圳市龙华区人民医院接受妇科腹腔镜手术的患者81例，随机分为TP组（对 乙酰氨基酚甘露醇注射液联合 QLB）、P组（行 OLB）和 S组（常规全身麻醉），每组 27例。麻醉诱导前 15 min TP组 静脉给予对乙酰氨基酚甘露醇注射液500 mg，P组和S组静脉给予等容量的生理盐水，诱导后3组在超声引导下行 双侧QLB（TP组和P组注入0.375%罗哌卡因20 mL，S组注入等容量生理盐水）。比较3组术后48 h内数字疼痛评 分（NRS）、舒适度评分（BCS）、镇痛补救治疗情况、镇痛泵按压次数、术中平均动脉压和心率、麻醉药消耗量、不良反 应发生情况及恢复质量评分（QoR-15）。结果 TP组在术后清醒时及术后 2~48 h的 NRS评分低于 S组，P组则在 术后清醒时及术后 2、8 h的 NRS评分均低于 S组（P < 0.01或 0.05）。TP组和 P组在术后 2 h的 BCS评分高于 S组， TP组在术后8 ~ 24 h的BCS评分高于S组，且在术后24 和48 h的BCS评分均高于P组（均P < 0.05）。术中TP组瑞 芬太尼用量少于S组（P < 0.05）。3组48 h内镇痛泵按压次数差异无统计学意义（P > 0.05），但TP组镇痛补救次数少 于S组（P < 0.05）。3 组术中不同时间点平均动脉压和心率、术后不良反应发生情况以及恢复质量差异无统计学 意义（P > 0.05）。结论 术前预先静脉注射对乙酰氨基酚甘露醇注射液联合QLB的多模式镇痛方案能显著提高妇 科腹腔镜术后的镇痛效果和患者舒适度，延长镇痛持续时间，减少阿片类药物的消耗。但该方案并未减少术后不 良反应及改善恢复效果。

Abstract:

Objective To observe the effect of paracetamol and mannitol injection combined with quadratus lumborum block (QLB) for multimodal analgesia after gynecological laparoscopic surgery. Methods A total of 81 patients receiving gynecological laparoscopic surgery in Longhua District People's Hospital of Shenzhen City from January to June 2024 were selected and randomly divided into three groups: the acetaminophen mannitol injection combined with QLB group (TP group), the QLB group (P group) and the routine general anesthesia group (S group), with 27 cases in each group. Paracetamol and mannitol injection 500 mg was administered intravenously 15 min before anaesthesia induction in TP group, and an equal volume of saline was given intravenously in P and S groups, and bilateral QLB was performed under ultrasound guidance in the three groups after induction (20 mL of 0.375% ropivacaine was injected in TP and P groups, and an equal volume of saline was injected in S group). Numeric rating scale (numeric rating scale, NRS), bruggrmann comfort scale (bruggrmann comfort scale, BCS), analgesic remedy treatment, number of analgesic pump presses, intraoperative mean arterial pressure and heart rate, anaesthetic consumption, occurrence of adverse effects, and quality of recovery score (quality of recovery-15, QoR-15) were compared among the three groups in the 48 h postoperative period. Results The NRS score of TP group was lower than that of S group at postoperative wakefulness and at 2 to 48 h after surgery, and the NRS score of P group was lower than that of S group at postoperative wakefulness and at 2 and 8 h after surgery (P< 0.01 or 0.05). The BCS scores of TP group and P group were higher than those of S group at 2 h postoperatively, and the BCS scores of TP group were higher than those of S group at 8-24 h postoperatively, and the BCS scores were higher in the TP group than in the P group at 24 h to 48 h postoperatively (P< 0.05). The intraoperative remifentanil dosage in the TP group was less than that in the S group (P< 0.05). There was no statistically significant difference in the number of analgesic pump presses in the three groups during 48 h (P> 0.05), but the number of analgesic remedies was more in group S than in group TP (P< 0.05). The differences in mean arterial pressure and heart rate at different intraoperative time points, the occurrence of adverse effects, and the quality of recovery among the three groups were not statistically significant (P>0.05). Conclusion The multimodal analgesia regimen of preoperative prophylactic intravenous paracetamol and mannitol injection combined with QLB significantly improves analgesia and patient comfort, prolongs analgesic duration, and reduces opioid consumption after gynecological laparoscopy. However, the regimen did not reduce postoperative adverse effects or improve the quality of recovery.