Application of transversus abdominis plane block in enhanced recovery after inguinal hernia repair

doi:10.3877/cma.j.issn.1674-392X.2020.03.006

Abstract

Abstract:

Objective

To observe the effect of transversus abdominis plane block (TAPB) in patients undergoing inguinal hernia repair.

Methods

From July 2017 to June 2019, one hundred patients (age more than 45 years old) undergoing inguinal hernia repair in the Drum Tower Hospital affiliated to Nanjing University Medical College were divided into either TAP block group (group T) or control group (group C), with 50 cases in each group. Group T was treated with transversus abdominis plane block after general anesthesia while group C was treated with general anesthesia. The visual analogue scale scores at rest and on movement were applied to evaluate pain degrees 2 hours after surgery (T1), 6 hours after surgery (T2), 12 hours after surgery (T3), 24 hours after surgery (T4), and 3 days after surgery (T5). The incidences of adverse reactions and the use of sedative drugs and analgesics after surgery were recorded. The hospital anxiety and depression scale (HADS) and mini-mental state examination (MMSE) were applied before surgery as well as 1, 3 and 7 days after surgery.

Results

The VAS scores during rest and movement in group T at T1, T2, T3 and T4 were lower than that in group C (P<0.05). The VAS scores on movement in group T at T5 were lower than that in group C (P<0.05). The use of sedative drugs and analgesics were significantly lower in group T than that of group C (P<0.05). The incidences of nausea and vomiting in group T were lower than those in group C (P<0.05). The scores of HADS in group T were lower than those in group C at one day after surgery (P<0.05). The scores of MMSE in group T were lower than those in group C at both one day and three days after surgery (P<0.05).

Conclusion

TAPB can be safely applied to patients undergoing inguinal hernia repair. It provides an efficacy for postoperative analgesia as well as prevents the accident of depression and cognitive dysfunction after surgery, which accords with the idea of enhanced recovery after surgery.

Key words: Hernia, inguinal, Herniorrhaphy, Transversus abdominis plane block

Juehao Zhang, Xuelin Yang, Kai Zhang. Application of transversus abdominis plane block in enhanced recovery after inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(03): 233-237.

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Figures/Tables 5

References 21

[1]	Erqonenc T, Beyaz SG, Ozocak, et al. Persistent postherniorrhaphy pain following inguinal hernia repair: A cross-sectional study of prevalence, pain characteristics, and effects on quality of life[J]. Int J Surg, 2017, 46: 126-132.
[2]	孙立，陈杰，申英末. 国产新型生物疝修补片与聚丙烯产品在腹股沟疝修补术中的疗效对比[J/CD]. 中华疝和腹壁外科杂志(电子版), 2019, 13(2): 101-104.
[3]	刘子嘉，黄宇光，罗爱伦. 麻醉与加速术后康复[J]. 中华麻醉学杂志, 2016, 36(8): 909-912.
[4]	李向南，李建立，容俊芳. 腹横肌平面阻滞在临床麻醉中的研究进展[J]. 河北医药, 2018(1): 2842-2846.
[5]	Smeds S, Nienhuijs S, Kullman E, et al. Identification and management of the ilio-inguinal and ilio-hypogastric nerves in open inguinal hernia repair: benefits of self-gripping mesh[J]. Hernia, 2016, 20(1): 33-41.
[6]	Bona S, Rosati R, Opocher E, et al. Pain and quality of life after inguinal hernia surgery: a multicenter randomized controlled trial comparing lightweight vs heavyweight mesh(Supermesh Study)[J]. Updates Surg, 2017, 70(1): 77-83.
[7]	Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery[J]. Hernia, 2011, 15(3): 239-249.
[8]	张笛，谭嗣伟，梁存河, 等. 腹股沟疝手术多模式镇痛及快通道外科研究进展[J/CD]. 中华疝和腹壁外科杂志(电子版), 2014, 8(4): 62-66.
[9]	Zhang Y, ChenY, Ma L. Depression and cardiovascular disease in elderly: Current understanding[J]. J Clin Neurosci, 2017, 47: 1-5.
[10]	Ji RR, Xu ZZ, Gao YJ. Emerging targets in neuroinflammation- driven chronic pain[J]. Nat Rev Drug Discov, 2014, 13(7): 533-548.
[11]	Huang Y, Coupland NJ, Lebel RM, et al. Structural changes in hippocampal subfields in major depressive disorder: A high-field magnetic resonance imaging study[J]. Biol Psychiatry, 2013, 74(1): 62-68.
[12]	Guo P, Hu S P. Thalidomide alleviates postoperative pain and spatial memory deficit in aged rats[J]. BiomedPharmacother, 2017, 95: 583-588.
[13]	Xuling L, Yang Y, Shengmei Z, et al. Inflammatory markers in postoperative delirium(POD) and cognitive dysfunction(POCD): A meta-analysis of observational studies[J]. PLoS One, 2018, 13(4): e0195659.
[14]	姜徽，李元海，周磊, 等. 不同镇痛方法对老年食管癌患者术后疼痛及早期认知功能的影响[J]. 临床麻醉学杂志, 2016, 32(5): 472-475.
[15]	Wang Y, Cheng J, Yang L, et al. Ropivacaine for Intercostal Nerve Block Improves Early Postoperative Cognitive Dysfunction in Patients Following Thoracotomy for Esophageal Cancer[J]. Med Sci Monit, 2019, 25: 460-465.
[16]	李静，董补怀，蔡文博, 等. 连续腰丛阻滞降低老年患者髋关节置换术后早期认知功能障碍的发生[J]. 中南大学学报(医学版), 2018, 43(8): 858-863.
[17]	Odor P M, Chis Ster I, Wilkinson I, et al. Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients: a retrospective cohort study[J]. BMC Anesthesiol, 2017, 17(1): 2.
[18]	杨学林，张凯，杜颖, 等. 超声引导下腹横肌平面阻滞对老年腹股沟疝修补术患者术后疼痛的影响[J/CD]. 中华疝和腹壁外科杂志(电子版), 2017, 11(6): 441-444.
[19]	Kassiani T, Panagiota P, Athanasia T, et al. The effect of transversus abdominis plane block on acute and chronic pain after inguinal hernia repair. A randomized controlled trial[J]. Int J Surg, 2019, 63: 63-70.
[20]	牟俊英，赵博，袁泉, 等. 超声引导腹横肌平面阻滞对无张力疝修补术后患者疼痛及生存质量的影响[J]. 实用医学杂志, 2018, 34(15): 2541-2543.
[21]	Arzu K, Mehmet AE, Ulku O, et al. Ultrasound-guided transversusbdominis plane block for postoperative analgesia in living liver donors: prospective, randomized, double-blinded clinical trial[J]. Clin Anesth, 2017, 37: 103-107.

组别	例数	性别(男/女)	年龄(岁,±s)	身高(cm,±s)	体重(kg,±s)	ASAⅡ/Ⅲ级(例)	手术时间(min,±s)
T组	50	48/2	66.4±10.3	170.0±6.9	67.8±8.0	29/21	42.4±16.6
C组	50	47/3	67.2±22.4	170.0±7.1	69.1±8.0	33/17	43.8±13.2
χ²/t值	?	0.003	0.229	0.000	0.813	0.002	0.467
P值	?	0.602	0.819	1.000	0.418	0.410	0.642

组别	例数	性别(男/女)	年龄(岁,±s)	身高(cm,±s)	体重(kg,±s)	ASAⅡ/Ⅲ级(例)	手术时间(min,±s)
T组	50	48/2	66.4±10.3	170.0±6.9	67.8±8.0	29/21	42.4±16.6
C组	50	47/3	67.2±22.4	170.0±7.1	69.1±8.0	33/17	43.8±13.2
χ²/t值	?	0.003	0.229	0.000	0.813	0.002	0.467
P值	?	0.602	0.819	1.000	0.418	0.410	0.642

组别	例数	丙泊酚(mg)	瑞芬太尼(μg)	芬太尼(μg)
T组	50	114.3±50.0	176.9±80.0	276.0±105.1
C组	50	184.7±50.1	232.6±54.4	351.0±96.6
t值	?	7.033	4.072	3.676
P值	?	0.000	0.000	0.000

组别	例数	丙泊酚(mg)	瑞芬太尼(μg)	芬太尼(μg)
T组	50	114.3±50.0	176.9±80.0	276.0±105.1
C组	50	184.7±50.1	232.6±54.4	351.0±96.6
t值	?	7.033	4.072	3.676
P值	?	0.000	0.000	0.000

组别	例数	静息					运动
组别	例数	T1	T2	T3	T4	T5	T1	T2	T3	T4	T5
T组	50	0.3±0.4	0.5±0.5	1.0±0.5	1.2±0.5	1.5±0.5	0.6±0.7	1.2±0.6	1.8±0.7	2.0±0.6	1.8±0.5
C组	50	0.6±0.6	1.1±0.6	1.7±0.5	2.0±0.4	1.6±0.5	1.4±0.9	2.0±0.6	2.5±0.8	2.4±0.7	2.0±0.5
t值	?	3.366	5.455	7.000	8.791	1.000	4.969	6.667	4.667	3.077	2.000
P值	?	0.001	0.000	0.000	0.000	0.320	0.000	0.000	0.000	0.003	0.048

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