Application of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament in bariatric surgery

Abstract

Objective To compare the analgesic effect of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) and transversus abdominis plane block (TAPB) in laparoscopic sleeve gastrectomy (LSG). Methods From January 2023 to January 2024, 90 patients underwent LSG in Suqian First People's Hospital were randomly divided into two groups: QLB-LSAL group and TAPB group, 45 cases in each group. Bilateral nerve block was performed before induction of general anesthesia, and 0.375% ropivacaine 20 mL was injected into each side of both groups. Both groups of patients received the same general anesthesia and postoperative patient-controlled intravenous analgesia (PCIA) regimen. The number of block dermatomes after block, mean arterial pressure (MAP), heart rate (HR), visual analogue scale (VAS) score were measured in different time. The intraoperative consumption of sufentanil and remifentanil, the interval time from the end of operation to the first pressing of the analgesia pump, the consumption of analgesics within 48 h after operation, the requirement for rescue analgesia, and the incidence of adverse reactions were recorded. Results The MAP and HR at 1 min and 5 min after skin incision, the intraoperative consumption of remifentanil, the VAS score at 2,6,12,24 h after operation, the consumption of analgesics within 48 h after operation, and the incidence of nausea and vomiting in QLB-LSAL group were significantly lower than those in TAPB group (P＜0.05). The number of block dermatomes at 5 min, 10 min, 6 h, 24 h after block, and the interval time from the end of operation to the first pressing of the analgesia pump in QLB-LSAL group were significantly higher than those in TAPB group (P＜0.05). There was no significant difference in the intraoperative consumption of sufentanil, the requirement for rescue analgesia, and the incidence of respiratory depression between the two groups (P＞0.05). Conclusion Ultrasound-guided QLB-LSAL combined with general anesthesia can stabilize hemodynamics, reduce the consumption of intraoperative opioids, and provide effective postoperative analgesia in patients received LSG.

Keywords

• ultrasound-guided， arcuate ligament， quadratus lumborum block， transversus abdominis plane block， laparoscopic sleeve gastrectomy， ropivacaine