探讨超声引导下腹横筋膜阻滞技术在老年腹股沟疝行Modified Kugel无张力疝修补术及TAPP术后镇痛的安全性和有效性。

对2019年1月1日至2020年1月30日在广东医科大学附属医院疝和腹壁外科诊断为腹股沟疝并同意择期行Modified Kugel无张力疝修补术者54例及TAPP术者70例行前瞻性对照研究。依据随机数字表法将Modified Kugel无张力疝修补术组（O组）分为观察组（O1组，脊椎麻醉+超声引导下腹横筋膜阻滞）20例，对照组（O2组，脊椎麻醉）34例；TAPP组（L组）分为观察组（L1组，气管插管全身麻醉+超声引导下腹横筋膜阻滞）31例，对照组（L2组，气管插管全身麻醉）39例。观察各组术后2 h、8 h、12 h、24 h、48 h的VAS评分、术后首次使用止痛药及首次离床活动时间、术后不良反应例数。并对不同术式观察组及对照组结果进行分析比较。

不同术式观察组2 h、8 h、12 h、24 h的VAS评分均明显低于对照组（P<0.05），首次使用止痛药时间均较对照组晚，首次离床活动时间明显早于对照组，不良反应发生率明显低于对照组，差异均有统计学意义（P<0.05）。

超声引导下腹横筋膜阻滞技术在腹股沟疝无张力修补术中有显著的镇痛效果，能促进患者术后快速康复。

To evaluate the safety and efficacy of ultrasound-guided transverse fascia plane block for postoperative analgesia of Modified Kugel tension-free hernia repair and TAPP in elderly inguinal hernia.

A prospective controlled study was performed on 54 patients who had been diagnosed with inguinal hernia and agreed to receive elective Modified Kugel tension-free hernia repair and 70 patients who had received TAPP at the Department of Hernia and Abdominal Wall Surgery of the Affiliated Hospital of Guangdong Medical University from January 1, 2019, to January 30, 2020. The patients in the Modified Kugel surgery group (O group) were divided into 20 patients in the observation group (O1 group) and 34 patients in the control group (O2 group) according to the random number table method. Among the 70 cases in the TAPP group (L group), 31 cases were divided into observation (L1 group) and 39 cases were divided into a control group (L2 group). VAS scores at 2 h, 8 h, 12 h, 24 h, and 48 h postoperatively, time of first use of painkillers, time out of bed, and the number of postoperative adverse reactions in the 4 groups were observed. The results of the observation groups with different surgical methods and the control groups were analyzed and compared.

VAS scores of different operation groups at 2 h, 8 h, 12 h, and 24 h were significantly lower than those of the control groups (P<0.05). The time of first postoperative use of analgesics in the observation groups was later than those in the control groups (P<0.05), the first time out of bed activity was significantly earlier than that in the control group (P<0.05), and the postoperative adverse reactions rates in the observation groups were lower than those in the control groups. The differences were statistically significant (P<0.05).

Ultrasound-guided transverse fascia plane block has a significant analgesic effect in tension-free inguinal hernia repair and promotes rapid postoperative recovery of patients.