Ultrasound-guided transverse abdominal planar block combined with laryngeal mask ventilation general anesthesia in pediatric indirect inguinal hernia surgery

doi:10.3877/cma.j.issn.1674-392X.2019.06.016

Abstract

Abstract:

Objective

To explore the effect of ultrasound-guided transverse abdominal planar block (TAPB) combined with laryngeal mask ventilation general anesthesia in pediatric indirect inguinal hernia surgery.

Methods

100 children with indirect inguinal hernia who underwent high ligation of hernia sac in Chengdu Women's & Children's Central hospital from January 2018 to October 2018 were selected and divided into control group (n=50) and observation group (n=50) according to random number table method. The control group was given laryngeal mask ventilation general anesthesia during operation, while the observation group was given ultrasound-guided TAPB combined with laryngeal mask ventilation general anesthesia during operation. The operation related indexes, hemodynamic indexes, FLACC and adverse reactions were observed in the two groups.

Results

The extubation time, anesthesia recovery time and hospitalization time in the observation group were significantly shorter than those in the control group [(6.27±1.86) minutes vs (13.31±2.05) minutes; (13.34±3.17) minutes vs (19.86±3.48) minutes; (2.26±0.14) days vs (3.15±1.17) days, P<0.05]. Compared with T1 period, HR, SBP and DBP in T2 and T3 period of observation group had no significant difference (P>0.05), HR in control group had no significant difference (P>0.05), and SBP and DBP increased gradually (P<0.05). HR in T1 period in observation group was not significantly different from that in control group (P>0.05), but in T2 and T3 period in observation group was significantly lower than that in control group (P<0.01). There was no significant difference in SBP and DBP in T1 period between the observation group and the control group (P>0.05), but in T2 and T3 period, SBP and DBP in the observation group were significantly lower than those in the control group (P<0.01). The FLACC scores of the two groups decreased gradually at the time of awakening, 2 h, 4 h and 8 h after operation (2.3±0.6, 2.0±0.4, 1.6±0.5, 1.2±0.3, respectively), and the observation group was significantly lower than the control group (3.0±0.5, 2.7±0.6, 2.2±0.3, 1.7±0.4, P<0.05). The incidence of vomiting, sore throat and laryngeal spasm in the observation group was lower than that in the control group (6.00% vs 20.00%, 6.00% vs 22.00%, 4.00% vs 18.00%, P<0.05).

Conclusion

Ultrasound-guided TAPB combined with laryngeal mask ventilation general anesthesia can better maintain the stability of hemodynamics and reduce the incidence of pain and adverse reactions in children with high ligation of hernia sac, which is worthy of clinical application.

Key words: Indirect inguinal hernia, Child, Ultrasound-guided transverse abdominal plane block, Laryngeal mask ventilation general anesthesia, Effect

Cheng Zhang, Zhenhua Huang, Jianzhong Shuai, Xiaoyan Xu. Ultrasound-guided transverse abdominal planar block combined with laryngeal mask ventilation general anesthesia in pediatric indirect inguinal hernia surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(06): 544-548.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2019.06.016

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2019/V13/I06/544

Figures/Tables 4

References 15

[1]	玉苏甫，阿克木，李凯, 等. 单孔腹腔镜治疗女儿童腹股沟疝的体会[J/CD]. 中华疝和腹壁外科杂志(电子版), 2016, 10(5): 349-351.
[2]	汪志勇，方进龙，涂远艳. 超声引导腹横肌平面阻滞联合Proseal喉罩通气麻醉在小儿腹腔镜疝囊高位结扎术中的应用[J]. 临床医学工程, 2017, 24(8): 1041-1042.
[3]	孙滨，马丽霜. 小儿疝与腹壁缺损疾病诊疗新进展[J/CD]. 中华疝和腹壁外科杂志(电子版), 2017, 11(2): 92-95.
[4]	Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway[J]. Anesthesiology, 2013, 118(2): 251-270.
[5]	Gürkan Y, Aksu C, Kuş A, et al. One operator's experience of ultrasound guided lumbar plexus block for paediatric hip surgery[J]. J Clin Monit Comput, 2017, 31(2): 331-336.
[6]	张成洋. 七氟烷联合氯胺酮复合麻醉用于小儿腹股沟斜疝手术的效果及安全性[J]. 医学综述, 2015, 21(15): 2879-2880.
[7]	Yildirim D, Hut A, Uzman S, et al. Spinal anesthesia is safe in laparoscopic total extraperitoneal inguinal hernia repair. A retrospective clinical trial[J]. Wideochir Inne Tech Maloinwazyjne, 2017, 12(4): 417-427.
[8]	周晓筠，吴靦，朱毅, 等. 不同麻醉方法对小儿腹腔镜手术应激反应和复苏质量的影响[J]. 实用医学杂志, 2017, 33(13): 2186-2188.
[9]	曹磊，吕生辉，胡伟. 喉罩与气管导管全麻应用于小儿腹腔镜疝修补术中的效果对比[J]. 贵州医药, 2017, 41(6): 624-625.
[10]	John R, Ranjan RV, Ramachandran TR, et al. Analgesic Efficacy of Transverse Abdominal Plane Block after Elective Cesarean Delivery-Bupivacaine with Fentanyl versus Bupivacaine Alone: A Randomized, Double-blind Controlled Clinical Trial[J]. Anesth Essays Res, 2017, 11(1): 181-184.
[11]	Desmet M, Helsloot D, Vereecke E, et al. Pneumoperitoneum Does Not Influence Spread of Local Anesthetics in Midaxillary Approach Transversus Abdominis Plane Block: A Descriptive Cadaver Study.[J]. Reg Anesth Pain Med, 2015, 40(4): 349-354.
[12]	熊虹飞，李思远，刘鸿涛, 等. 超声引导下腹横肌平面阻滞在新生儿下腹部手术中的应用[J]. 临床麻醉学杂志, 2018, 34(08): 59-61.
[13]	刘炯峰，李敬业，黄志强. 超声引导下腹横肌平面阻滞联合喉罩通气全身麻醉在小儿疝囊高位结扎术中的应用效果[J]. 吉林医学, 2018, 39(3): 490-492.
[14]	冯慧悦，吴祎洁. 单纯喉罩全身麻醉及合并超声引导腹横肌平面阻滞对小儿疝囊高位结扎术麻醉效果的影响[J]. 中国现代医学杂志, 2016, 26(7): 112-115.
[15]	翁洪亮，范成云，王明敬. 超声引导腹横肌平面阻滞联合喉罩通气麻醉在小儿腹腔镜疝囊高位结扎术中的应用[J]. 山东医药, 2014, 54(47): 73-75.

组别	例数	拔管时间(min)	麻醉苏醒时间(min)	住院时间(d)
观察组	50	6.27±1.86	13.34±3.17	2.26±0.14
对照组	50	13.31±2.05	19.86±3.48	3.15±1.17
t值	?	17.984	9.259	5.341
P值	?	<0.001	<0.001	<0.001

组别	例数	拔管时间(min)	麻醉苏醒时间(min)	住院时间(d)
观察组	50	6.27±1.86	13.34±3.17	2.26±0.14
对照组	50	13.31±2.05	19.86±3.48	3.15±1.17
t值	?	17.984	9.259	5.341
P值	?	<0.001	<0.001	<0.001

时间	组别	例数	心率(次/min)	收缩压(mmHg)	舒张压(mmHg)
T₁	观察组	50	86.70±9.40	107.90±10.70	64.70±6.20
	对照组	50	87.20±9.10	107.60±10.50	64.30±6.40
	t值	?	0.270	0.142	0.317
	P值	?	0.788	0.888	0.752
T₂	观察组	50	86.5±8.6	105.8±11.4	62.6±5.9
	对照组	50	103.2±7.3	118.6±9.6^a	71.8±5.3^a
	t值	?	10.531	6.073	8.203
	P值	?	<0.001	<0.001	<0.001
T₃	观察组	50	85.8±8.2	105.3±11.7	61.7±5.4
	对照组	50	96.6±8.5	121.4±10.8^a	73.8±5.1^a
	t值	?	6.466	7.150	11.519
	P值	?	<0.001	<0.001	<0.001

时间	组别	例数	心率(次/min)	收缩压(mmHg)	舒张压(mmHg)
T₁	观察组	50	86.70±9.40	107.90±10.70	64.70±6.20
	对照组	50	87.20±9.10	107.60±10.50	64.30±6.40
	t值	?	0.270	0.142	0.317
	P值	?	0.788	0.888	0.752
T₂	观察组	50	86.5±8.6	105.8±11.4	62.6±5.9
	对照组	50	103.2±7.3	118.6±9.6^a	71.8±5.3^a
	t值	?	10.531	6.073	8.203
	P值	?	<0.001	<0.001	<0.001
T₃	观察组	50	85.8±8.2	105.3±11.7	61.7±5.4
	对照组	50	96.6±8.5	121.4±10.8^a	73.8±5.1^a
	t值	?	6.466	7.150	11.519
	P值	?	<0.001	<0.001	<0.001

组别	例数	苏醒时	术后2 h	术后4 h	术后8 h
观察组	50	2.3±0.6	2.0±0.4	1.6±0.5	1.2±0.3
对照组	50	3.0±0.5	2.7±0.6	2.2±0.3	1.7±0.4
t值	?	40.170	47.114	57.940	49.999
P值	?	<0.001	<0.001	<0.001	<0.001

Please choose a citation manager

Content to export