关键词: 胆囊结石, 罗哌卡因, 肋下前路腰方肌阻滞, 腹腔镜胆囊切除术, 镇痛

Abstract: Objective The aim of this study was to investigate analgesiaof ultrasound-guided subcostal anterior quadratus lumborumblockwith ropivacaine in patients with gallbladder diseases undergoinglaparoscopic cholecystectomy (LC). Methods 106 patients with gallbladder diseases, including gallbladder stones were encountered in our hospital between March 2022 and September 2023, and were randomly divided into control group (n=53) and observation group (n=53). All patients underwent LC, and after induction of general anesthesia, thepatients in the control group were given bilateral transversus abdominis plane block with 20 mL of 0.25% ropivacaine,while the patients in the observation group was given ultrasound-guided subcostal anterior quadratus lumborumblock with 20 mL of 0.25% ropivacaine. Hemodynamic parameters was monitored before (TO) and 10 minafter intubation (T1), and 10 minafter extubation (T2). Serum interleukin-6 (IL-6),C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), cortisol (Cor), norepinephrine (NE) and adrenaline (AD) levels were assayed by ELISA. Results Time of first pressing analgetic pump in the observation groupwas (5.5±0.7) h, significantly longer than that in the control group [(2.4±0.5) h, P<0.05], timeof first off-bed activity and times of remedial analgesia in the observation group were (16.3±1.7)h and (2.5±0.4)times, much shorter or less than [(20.5±2.4)h and (3.3±0.5)times, P<0.05] in the control; by 6 h, 12 h and 24 h after operation, resting visual analogue scale score was much lower than in the control (P<0.05); by T1 and T2, systolic blood pressure, diastolic blood pressure and heart rate were much lower or slower than in the control(P<0.05); at 6 h after operation, serum IL-6, CRP and TNF-α levels were (70.3±8.2)pg/mL, (69.5±8.4)mg/L and (12.6±1.4)pg/mL, all significantly lower than [(85.2±8.6)pg/mL, (84.5±8.6)mg/L and (19.3±1.6)pg/mL, respectively, P<0.05] in the control; serum Cor, NE and AD levels were (162.5±16.7)ng/mL, (231.5±24.6)μg/L and (106.4±12.7)μg/L, all much lower than [(194.3±19.5)ng/mL, (266.7±28.3)μg/L and (134.3±13.5)μg/L, respectively, P<0.05] in the control group; incidence of adverse effects in the observation was 9.5%, much lower than 24.5%(P<0.05)in the control. Conclusion Ultrasound-guided subcostal anterior quadratus lumborum block with ropivacaine could achieve a good analgesic effect in patients with gallbladder diseases undergoing LC, which might be related to inhibition of body inflammation and stress reactions.

Key words: Gallbladder stones, Laparoscopic cholecystectomy, Ropivacaine, Subcostal anterior quadratus lumborum block, Analgesia