Many studies confirmed that several approaches of quadratus lumborum block (QLB) were superior to transversus abdominis plane block (TAPB) in reducing opioid consumption during postoperative period. As a new QLB approach at the lateral supra-arcuate ligament (QLB-LSAL), the analgesic efficacy and safety in patients undergoing open hepatectomy are still unknown. This study aims to compare postoperative analgesia between the blocks in open hepatectomy. Patients and Methods: Sixty-two patients undergoing open hepatectomy were enrolled and randomly allocated into the QLB-LSAL group (group Q) and the subcostal TAPB group (group T). Preoperatively, patients received ultrasound-guided bilateral QLB-LSAL or subcostal TAPB with injection of 0.5% ropivacaine (a total volume of 40 mL). The primary outcome was cumulative total morphine equivalent consumption in the first postoperative 24 h. Other outcomes included numerical rating scale (NRS) scores at rest and coughing, cumulative total morphine equivalent consumption at 2, 6, 12, 48 h, Quality of Recovery-15 (QoR-15) scores, time to first patient-controlled intravenous analgesia (PCIA) request, time to first ambulation and adverse effects. Results: The cumulative total morphine equivalent consumption in group Q was decreased significantly at all postoperative time points (P < 0.01). The postoperative NRS scores at rest and coughing in group Q were lower than those in group T at all postoperative time points except 48 h (P < 0.05). A significant increase was also observed in the QoR-15 scores among patients in group Q. Time to first PCIA request was significantly prolonged in group Q than in group T, and time to first ambulation was shortened. Adverse effects showed no statistical significance between the two groups. Conclusion: Compared with subcostal TAPB, preoperative bilateral QLB-LSAL provided superior analgesic properties and promoted early postoperative recovery quality in patients undergoing open hepatectomy. Trial Registration: China Clinical Trials Registration Center (http://www.chictr.org.cn) ChiCTR2200063291, 3/9/2022.
Background There is high incidence of postoperative residual curarization(PORC)in elderly patients. Ionised calcium plays a significant role in the neuromuscular junction. Objective to investigate the effect of using different doses of calcium gluconate on residual neuromuscular blockade༈NMB༉after laparoscopy in elderly patients, and also to observe its clinical safety and dose-effect relationship. Methods One hundred and eighty elderly patients who underwent elective laparoscopic surgery were randomly divided into four groups, the experimental group of 5 mg/kg, 10 mg/kg, 20 mg/kg calcium gluconate injection combined with neostigmine (C5 group, C10 group, C20 group) and the neostigmine group (N group), 45 cases in each group. At the end of the operation, when TOFc(train-of-four count) was ≥ 3, patients received 40 ug/kg neostigmine with 20 ug/kg atropine intravenously, while C5, C10, and C20 group received additional calcium gluconate 5 or 10 or 20 mg/kg. The time of TOFr (T4 /T1 ) ≥ 0.90 and the incidence of PORC at 5, 10, 15 and 20 minutes after neostigmine administration were observed in the four groups. Results The time of TOFr ≥ 0.90 was 11.50 (9.25,14.75) min in the control group, 7.50 (6.00,9.00) min in the C5 group, 9.50 (8.00,12.00) min in the C10 group and 10.00 (9.00,12.00) min in the C20 group (P<0.001). The incidence of PORC after extubation was 27 (67.5%) in N group, 21 (52.5%) in C5 group 12 (30%) in C10 group and 7 (17.5%) in C20 group (P<0.001). There were no differences between the four groups with respect to the incidence of PORC at 5 and 15min after administration of neostigmine. Conclusions Calcium gluconate can be safely used for promoting early postoperative NMB recovery of cis-atracurium in elderly patients, and the recovery process was more stable in the C20 group.
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