{"title":"腹腔镜肾癌手术中竖脊肌平面阻滞与腰方肌阻滞的镇痛效果比较：一项双盲随机试验。","authors":"Meng Zhang, Shuchuan Zhao, Siyuan Song, Huixian Zhou, Mingfang Li, Peng Su, Guangmin Xu","doi":"10.21037/tau-2025-71","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided erector spinae plane block (ESPB) and quadratus lumborum block (QLB) are increasingly used for perioperative analgesia. However, their comparative efficacy, opioid-sparing effects, and impact on recovery outcomes in patients undergoing laparoscopic renal cancer resection remain unclear. This study aimed to directly compare the analgesic effectiveness and recovery benefits of ESPB versus QLB in this surgical population.</p><p><strong>Methods: </strong>In this randomized, double-blind trial, 54 patients scheduled for laparoscopic nephrectomy were allocated to receive either ESPB or QLB with 25 mL of 0.4% ropivacaine under ultrasound guidance. Postoperative analgesia was managed using morphine-based patient-controlled analgesia. The primary outcome was cumulative morphine consumption within 6 hours postoperatively. Secondary outcomes included pain scores, morphine pump activations, the 15-item Quality of Recovery scale (QoR-15) scores, and length of hospital stay.</p><p><strong>Results: </strong>Patients receiving ESPB had significantly lower morphine consumption during the first 6 hours postoperatively compared to those receiving QLB (4.11±4.05 <i>vs.</i> 6.63±4.61 mg, P<0.05). ESPB was also associated with lower early pain scores, fewer morphine pump activations, higher QoR-15 scores at 24 and 48 hours, and shorter hospitalization (P<0.05 for all). No block-related complications were observed in either group.</p><p><strong>Conclusions: </strong>Compared with QLB, ESPB may provide more effective early postoperative analgesia and enhanced recovery in patients undergoing laparoscopic renal cancer surgery. These findings suggest that ESPB may be a valuable option for perioperative pain management in laparoscopic nephrectomy; however, as an exploratory study with limited sample size, further validation in larger populations is necessary.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2300074743.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"14 7","pages":"2029-2042"},"PeriodicalIF":1.7000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336726/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative analgesic efficacy of erector spinae plane block versus quadratus lumborum block in laparoscopic renal cancer surgery: a double-blind randomized trial.\",\"authors\":\"Meng Zhang, Shuchuan Zhao, Siyuan Song, Huixian Zhou, Mingfang Li, Peng Su, Guangmin Xu\",\"doi\":\"10.21037/tau-2025-71\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Ultrasound-guided erector spinae plane block (ESPB) and quadratus lumborum block (QLB) are increasingly used for perioperative analgesia. However, their comparative efficacy, opioid-sparing effects, and impact on recovery outcomes in patients undergoing laparoscopic renal cancer resection remain unclear. This study aimed to directly compare the analgesic effectiveness and recovery benefits of ESPB versus QLB in this surgical population.</p><p><strong>Methods: </strong>In this randomized, double-blind trial, 54 patients scheduled for laparoscopic nephrectomy were allocated to receive either ESPB or QLB with 25 mL of 0.4% ropivacaine under ultrasound guidance. Postoperative analgesia was managed using morphine-based patient-controlled analgesia. The primary outcome was cumulative morphine consumption within 6 hours postoperatively. Secondary outcomes included pain scores, morphine pump activations, the 15-item Quality of Recovery scale (QoR-15) scores, and length of hospital stay.</p><p><strong>Results: </strong>Patients receiving ESPB had significantly lower morphine consumption during the first 6 hours postoperatively compared to those receiving QLB (4.11±4.05 <i>vs.</i> 6.63±4.61 mg, P<0.05). ESPB was also associated with lower early pain scores, fewer morphine pump activations, higher QoR-15 scores at 24 and 48 hours, and shorter hospitalization (P<0.05 for all). No block-related complications were observed in either group.</p><p><strong>Conclusions: </strong>Compared with QLB, ESPB may provide more effective early postoperative analgesia and enhanced recovery in patients undergoing laparoscopic renal cancer surgery. These findings suggest that ESPB may be a valuable option for perioperative pain management in laparoscopic nephrectomy; however, as an exploratory study with limited sample size, further validation in larger populations is necessary.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2300074743.</p>\",\"PeriodicalId\":23270,\"journal\":{\"name\":\"Translational andrology and urology\",\"volume\":\"14 7\",\"pages\":\"2029-2042\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-07-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336726/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Translational andrology and urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/tau-2025-71\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"ANDROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational andrology and urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tau-2025-71","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/28 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ANDROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：超声引导的竖脊肌平面阻滞（ESPB）和腰方肌阻滞（QLB）越来越多地用于围手术期镇痛。然而，它们的比较疗效、阿片类药物节约效果以及对腹腔镜肾癌切除术患者恢复结果的影响尚不清楚。本研究旨在直接比较ESPB与QLB在该手术人群中的镇痛效果和恢复效果。方法：在本随机双盲试验中，54例计划行腹腔镜肾切除术的患者在超声引导下接受25 mL 0.4%罗哌卡因的ESPB或QLB治疗。术后镇痛采用吗啡为基础的患者自控镇痛。主要观察指标为术后6小时内吗啡的累计用量。次要结局包括疼痛评分、吗啡泵激活、15项康复质量量表（QoR-15）评分和住院时间。结果：与QLB组相比，ESPB组患者术后前6小时吗啡用量显著降低（4.11±4.05 mg vs. 6.63±4.61 mg）。结论：与QLB组相比，ESPB组可为腹腔镜肾癌手术患者提供更有效的术后早期镇痛和促进恢复。这些发现表明ESPB可能是腹腔镜肾切除术围手术期疼痛管理的一个有价值的选择；然而，作为一项样本量有限的探索性研究，需要在更大的人群中进一步验证。试验注册：中国临床试验注册中心，ChiCTR2300074743。
Comparative analgesic efficacy of erector spinae plane block versus quadratus lumborum block in laparoscopic renal cancer surgery: a double-blind randomized trial.
Background: Ultrasound-guided erector spinae plane block (ESPB) and quadratus lumborum block (QLB) are increasingly used for perioperative analgesia. However, their comparative efficacy, opioid-sparing effects, and impact on recovery outcomes in patients undergoing laparoscopic renal cancer resection remain unclear. This study aimed to directly compare the analgesic effectiveness and recovery benefits of ESPB versus QLB in this surgical population.
Methods: In this randomized, double-blind trial, 54 patients scheduled for laparoscopic nephrectomy were allocated to receive either ESPB or QLB with 25 mL of 0.4% ropivacaine under ultrasound guidance. Postoperative analgesia was managed using morphine-based patient-controlled analgesia. The primary outcome was cumulative morphine consumption within 6 hours postoperatively. Secondary outcomes included pain scores, morphine pump activations, the 15-item Quality of Recovery scale (QoR-15) scores, and length of hospital stay.
Results: Patients receiving ESPB had significantly lower morphine consumption during the first 6 hours postoperatively compared to those receiving QLB (4.11±4.05 vs. 6.63±4.61 mg, P<0.05). ESPB was also associated with lower early pain scores, fewer morphine pump activations, higher QoR-15 scores at 24 and 48 hours, and shorter hospitalization (P<0.05 for all). No block-related complications were observed in either group.
Conclusions: Compared with QLB, ESPB may provide more effective early postoperative analgesia and enhanced recovery in patients undergoing laparoscopic renal cancer surgery. These findings suggest that ESPB may be a valuable option for perioperative pain management in laparoscopic nephrectomy; however, as an exploratory study with limited sample size, further validation in larger populations is necessary.
Trial registration: Chinese Clinical Trial Registry, ChiCTR2300074743.
期刊介绍：
ranslational Andrology and Urology (Print ISSN 2223-4683; Online ISSN 2223-4691; Transl Androl Urol; TAU) is an open access, peer-reviewed, bi-monthly journal (quarterly published from Mar.2012 - Dec. 2014). The main focus of the journal is to describe new findings in the field of translational research of Andrology and Urology, provides current and practical information on basic research and clinical investigations of Andrology and Urology. Specific areas of interest include, but not limited to, molecular study, pathology, biology and technical advances related to andrology and urology. Topics cover range from evaluation, prevention, diagnosis, therapy, prognosis, rehabilitation and future challenges to urology and andrology. Contributions pertinent to urology and andrology are also included from related fields such as public health, basic sciences, education, sociology, and nursing.
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