Analgesic effect of posterior quadratus lumborum block combined with cocktail therapy after arthroscopic anterior cruciate ligament reconstruction surgery
10.3760/cma.j.cn341190-20231211-00558
- VernacularTitle:后路QLB联合鸡尾酒疗法在关节镜ACLR术后镇痛中的效果分析
- Author:
Xiongwei MA
1
;
Bao LEI
;
Yan WANG
;
Hongwei TONG
Author Information
1. 北京大学第三医院延安分院 延安市中医医院麻醉科，延安 716000
- Keywords:
Arthroscopy;
Ultrasonic surgical procedures;
Anterior cruciate ligament reconstruction;
Anesthesia and analgesia;
Anesthetics,local;
Knee joint;
Visual anal
- From:
Chinese Journal of Primary Medicine and Pharmacy
2024;31(9):1339-1345
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the analgesic effect of ultrasound-guided posterior quadratus lumborum block (QLB) combined with cocktail therapy after arthroscopic anterior cruciate ligament reconstruction (ACLR) surgery.Methods:A randomized controlled study was conducted on 87 patients who underwent arthroscopic ACLR surgery at the Yan'an Branch of Peking University Third Hospital (Yan'an Hospital of Traditional Chinese Medicine) from February 2021 to April 2023. The patients were randomly divided into three groups using the random number table method: Group A ( n = 29), Group B ( n = 29), and Group C ( n = 29). Group A received ultrasound-guided posterior QLB, Group B received cocktail therapy, and Group C received a combination of ultrasound-guided posterior QLB and cocktail therapy. Visual Analogue Scale (VAS) scores, knee function, intraoperative and postoperative general conditions, stress responses, inflammatory pain mediators, and adverse reactions were compared among the three groups. Results:At 2, 12, and 24 hours after surgery, VAS scores in Group C were (3.25 ± 0.41) points, (2.03 ± 0.28) points, and (0.65 ± 0.09) points, respectively, which were significantly lower than those in Group A [(4.68 ± 0.65) points, (3.28 ± 0.39) points, (1.68 ± 0.22) points, t = 10.02, 14.02, 23.34, all P < 0.001] and Group B [(4.79 ± 0.72) points, (3.20 ± 0.36) points, (1.72 ± 0.24) points, t = 9.49, 13.82, 22.48, all P < 0.001]. At 1 month after surgery, the Knee Society Score and Hospital for Special Surgery knee score in Group C were (92.02 ± 3.33) points and (90.05 ± 3.46) points, respectively, both of which were significantly higher than those in Group A [(81.85 ± 2.27) points, (82.57 ± 2.34) points, t = 13.59, 9.64, both P < 0.001] and Group B [(81.46 ± 2.38) points, (83.22 ± 2.40) points, t = 13.89, 8.73, both P < 0.001]. There were no statistically significant differences in maximum active range of motion and quadriceps strength among the three groups at 72 hours after surgery (both P > 0.05). The time to first ambulation, time to first straight leg raise, rate of rescue analgesia, and the number of effective activations of the analgesic pump in Group C were (22.08 ± 4.36) hours, (2.26 ± 0.30) hours, 3.45%, and (0.75 ± 0.16) times, respectively, all of which were significantly lower than those in Group A ( t = 3.24, 8.20, χ2 = 7.73, t = 19.29, all P < 0.001) and Group B ( t = 3.01, 7.51, χ2 = 6.44, t = 17.34, all P < 0.001). At 24 hours after surgery, serum levels of angiotensin II, adrenocorticotropin, β-endorphin, and prostaglandin E 2 in Group C were significantly lower than those in Groups A and B (all P < 0.05). There was no statistically significant difference in the incidence of adverse reactions among the three groups ( P > 0.05). Conclusion:The combination of cocktail therapy and ultrasound-guided posterior QLB can improve knee function in patients after arthroscopic ACLR surgery and provides effective and safe analgesia.
