Modified strategy of anesthesia for laparoscopic radical resection of rectal carcinoma: ultrasound-guided anterior quadratus lumborum block combined with general anesthesia

Abstract

Objective To evaluate the efficacy of ultrasound-guided anterior quadratus lumborum block combined with general anesthesia for laparoscopic radical resection of rectal carcinoma. Methods A total of 80 patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 40-64 yr, scheduled for elective laparoscopic radical resection of rectal carcinoma, were divided into 2 groups (n=40 each) using a random number table method: anterior quadratus lumborum block combined with general anesthesia group(group QG)and general anesthesia group(group G). In group QG, anterior quadratus lumborum block was performed with 0.33% ropivacaine 25 ml and dexamethasone 5 mg under ultrasound guidance before operation, and the same procedure was performed on the other side.Combined intravenous-inhalational anesthesia was applied, propofol 3-5 μg/ml and remifentanil 3-5 ng/ml were given by target-controlled infusion, and cisatracurium was intermittently injected in two groups.Patient-controlled intravenous analgesia with sufentanil 2 μg/kg was used for postoperative analgesia.The analgesic pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval.Bruggrmann comfort scale(BCS)scores were recorded at 1, 6, 12, 24 and 48 h after operation(T1-5). Tramadol was used for rescue analgesic after operation.The consumption of remifentanil and sufentanil, requirement for tramadol, occurrence of adverse reactions and patients′ satisfaction with postoperative analgesia were recorded.The emergence time, first ambulation time, time to first flatus/poo and length of hospital stay were also recorded.The development of anterior quadratus lumborum block-related complications was recorded. Results Compared with group G, BCS scores were significantly increased at T4, 5, the consumption of remifentanil, requirement for tramadol and incidence of nausea and vomiting were decreased, patients′ satisfaction with postoperative analgesia was increased, and the emergence time, first ambulation time, time to first flatus/poo and length of hospital stay were shortened in group QG(P<0.05). Conclusion Ultrasound-guided anterior quadratus lumborum block combined with general anesthesia can reduce the consumption of opioids in the perioperative period and is helpful in improving outcomes when used for laparoscopic radical resection of rectal carcinoma. Key words: Psoas muscles; Nerve block; Anesthesia, general; Colorectal surgery; Laparoscopy