目的

观察纳布啡复合罗哌卡因注射液用于超声引导下髂腹下/髂腹股沟神经阻滞（IH/IINB）对腹股沟疝修补术后疼痛及早期恢复质量的影响。

方法

本研究采用前瞻性随机、三盲对照。选取2020年12月至2022年12月，于徐州市中医院择期行腹股沟疝无张力修补术（改良Kugel术式）的患者88例，采用随机数字表法分为罗哌卡因组（L组，IH/IINB采用盐酸罗哌卡因+生理盐水）和纳布啡联合罗哌卡因组（N组，IH/IINB采用盐酸纳布啡+盐酸罗哌卡因+生理盐水），各44例。2组患者均接受患侧IH/IINB（总用量30 ml）。询问并记录术后6、12、24 h的静息和运动疼痛视觉模拟评分（VAS），手术当晚睡眠被疼痛干扰次数，统计术后首次给予止痛药时间及24 h内镇痛药使用次数，并记录24 h内最高VAS评分。记录术后肛门排气时间、首次下床时间及不良反应发生情况（尿潴留、恶心、呕吐、嗜睡等）。

结果

与L组比较，复合纳布啡可以降低患者术后6、12、24 h的静息和运动VAS评分（F_交互=10.28，P_交互＜0.001；F_交互=18.19，P_交互＜0.001），减少24 h内额外镇痛药物需求量，并且改善手术当晚睡眠质量，减少恶心、呕吐的发生，促进术后早期恢复（P＜0.05）。2组其他不良反应指标比较，差异无统计学意义（P＞0.05）。

结论

对于腹股沟疝修补术患者实施超声引导下IH/IINB镇痛效果满意，复合纳布啡可延长罗哌卡因镇痛时长，改善手术当晚睡眠质量，减少不良反应的发生，加速术后康复。

Objective

To investigate the efficacy of ultrasound-guided iliohypogastric and ilioinguinal nerve block （IH/IINB） with nalbuphine and ropivacaine for analgesia and early recovery in inguinal hernia.

Methods

This study employed a prospective randomized， triple-blind controlled trial.From December 2020 to December 2022， a total of 88 patients who underwent elective tension-free inguinal hernia repair （modified Kugel procedure） at Xuzhou Traditional Chinese Medicine Hospital were enrolled in the study. Using a random number table method， they were randomly divided into the Ropivacaine group （L group， receiving IH/IINB with ropivacaine hydrochloride and normal saline） and the Nalbuphine combined with Ropivacaine group （N group， receiving IH/IINB with nalbuphine hydrochloride， ropivacaine hydrochloride， and normal saline）， with 44 patients in each group. All patients received the ultrasound-guided IH/IINB before surgery with 30 ml for the ipsilateral side. The visual analog scale （VAS） scores for resting and exercise pain were asked and recorded at 6， 12， and 24 hours after surgery. The times of sleep disturbance by pain were counted on the night of surgery. The time of first postoperative administration of painkillers and the times of use of analgesics within 24 hours were counted，and the highest VAS scores within 24 hours were recorded. Postoperative anal exhaust time， first time of getting out of bed and occurrence of adverse reactions （urinary retention， nausea， vomiting， drowsiness，etc.） were recorded.

Results

Compared with the L group alone， combined nalbuphine could reduce the VAS scores for resting and exercise pain at 6， 12， and 24 h after surgery （F_interaction=10.28， P_interaction＜0.001； F_interaction =18.19， P_interaction ＜0.001）， reduce the need for additional analgesic drugs within 24 h，improve the sleep quality on the night of surgery， reduce the occurrence of nausea and vomiting， and promote the early recovery after surgery （P＜0.05）. There was no significant difference in other adverse reactions between the two groups （P＞0.05）.

Conclusion

For patients undergoing inguinal hernia repair，the analgesic effect of ultrasound-guided IH/IINB is satisfactory， and the compound nalbuphine can prolong the analgesic time of ropivacaine， improve sleep on the night of the operation， reduce the occurrence of adverse reactions， and accelerate postoperative recovery.