Comparison of the application effect of continuous IINB and TAPB under ultrasound guidance in elderly inguinal hernia surgery

doi:10.3877/cma.j.issn.1674-392X.2023.05.020

Abstract

Abstract:

Objective

To investigate the influence of ultrasound-guided continuous ilioinguinal and ilioinferior ventral nerve block (IINB) and transversal abdominis plane block (TAPB) on the analgesic effect, stress response and adverse reactions of inguinal hernia repair in the elderly.

Methods

A total of 84 elderly patients with inguinal hernia who underwent unilateral complete peritoneal hernia repair under laparoscopy in Wenchang People's Hospital from May 2020 to May 2022 were selected as the study objects. According to the random number table method, they were divided into the observation group (receiving continuous IINB under ultrasound guidance) and the control group (receiving TAPB under ultrasound guidance), with 42 cases in each group. Prince-Henry score, norepinephrine (NE), cortisol, time of first analgesic pump compression, number of analgesic pump compression, dosage of ropivacaine, duration of eye opening and incidence of adverse reactions were compared.

Results

Repeated measurement ANOVA showed that the time effect and inter-group effect of the Prince Henry score between the two groups were statistically significant (P<0.05), while the interaction between time and group was not statistically significant (P>0.05). There were significant differences in the time effect, intergroup effect and interaction between time and group of NE and cortisol between the two groups (P<0.05). Pairwise comparison showed that the Prince-Henry scores of the observation group were lower than those of the control group at the time of recovery, 2, 6, 12 and 24 hours after surgery (P<0.05). The NE and cortisol levels of T1 (30 min after incision), T2 (after surgery) and T3 (12 h after surgery) in the observation group were lower than those in the control group (P<0.05). The first time of analgesic pump compression in the observation group was later than that in the control group, the times of analgesic pump compression were less than those in the control group (P<0.05). There was no significant difference in the dosage of ropivacaine, duration of eye opening, and the incidence of total adverse reactions between the two groups (P>0.05).

Conclusion

Ultrasound-guided continuous IINB has a good analgesic effect in elderly inguinal hernia repair, which can reduce the stress reactions and relieve pain .

Key words: Ultrasound, Anesthesia, Hernia, inguinal, Herniorrhaphy, Elderly

Wei Sun, Li Lin, Gaoyang Shi. Comparison of the application effect of continuous IINB and TAPB under ultrasound guidance in elderly inguinal hernia surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 593-597.

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References 21

[1]	朱尤壮, 柴军, 杨福全, 等. 超声引导下腹横肌平面两点阻滞在高危老年患者腹股沟疝修补术中的应用[J]. 中华普通外科杂志, 2021, 36(11): 835-840.
[2]	李争卫, 何爱萍, 赵玲, 等. 超声引导下连续IINB在老年腹股沟疝修补术中的应用效果及对患者术后镇痛和恢复的影响[J]. 医学综述, 2022, 28(8): 1660-1664.
[3]	许滔, 唐国强, 贺光宏, 等. 超声引导下连续髂腹下和髂腹股沟神经阻滞在高龄疝修补术后镇痛效果评价[J]. 中国煤炭工业医学杂志, 2021, 24(4): 361-365.
[4]	中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(4): 244-246.
[5]	Takamori S, Yoshida S, Hayashi A, et al. Intraoperative intercostal nerve blockade for postthoracotomy pain[J]. Ann Thorac Surg, 2002, 74(2): 338-341.
[6]	郭颖, 许军, 朱宏, 等. 超声引导下罗哌卡因双侧肋缘下腹横肌平面阻滞对老年胆囊切除术患者镇痛效果研究[J]. 川北医学院学报, 2021, 36(5): 568-572.
[7]	胡松权, 宋劼, 周群. 超声引导腹横肌平面阻滞联合腹直肌鞘阻滞在腹腔镜全子宫切除术患者中的应激状况及术后镇痛效果[J]. 中国妇幼保健, 2022, 37(6): 1140-1143.
[8]	来源, 张锦, 李凯. 右美托咪定不同给药方式对老年腹股沟疝无张力修补术患者神经阻滞麻醉效果与安全性的影响[J]. 药物不良反应杂志, 2020, 22(5): 283-288.
[9]	庞西, 谭颖, 王丽, 等. 超声引导下腰方肌阻滞与腹横肌平面阻滞在剖宫产术后镇痛中的比较[J]. 四川医学, 2021, 42(7): 659-664.
[10]	唐佳, 张慕春, 王朵朵, 等. 右美托咪定联合罗哌卡因腹横肌平面阻滞对老年腹腔镜胃癌根治术患者应激反应、炎症反应及术后谵妄的影响[J]. 现代生物医学进展, 2021, 21(19): 3743-3747.
[11]	张宇, 于天雷, 杨波, 等. 超声引导下连续股神经阻滞对老年膝关节置换术后血流动力学及血液流变学的影响[J]. 临床超声医学杂志, 2020, 22(2): 142-145.
[12]	童卫国, 孙桂珍. 甲磺酸罗哌卡因与左旋布比卡因在疝囊高位结扎术超声引导腹横肌平面阻滞中的应用比较[J]. 临床外科杂志, 2022, 30(6): 535-538.
[13]	Ceccanti S, Cervellone A, Pesce MV, et al. Feasibility, safety and outcome of inguinal hernia repair under spinal versus general anesthesia in preterm and term infants[J]. J Pediatr Surg, 2021, 56(5): 1057-1061.
[14]	凤旭东, 鲍乐乐, 孔二亮, 等. 超声引导下腰方肌阻滞在经腹直肠癌根治术后镇痛中的应用效果[J]. 中国药物与临床, 2021, 21(14): 2430-2432.
[15]	Hajibandeh S, Hajibandeh S, Mobarak S, et al. Meta-Analysis of Spinal Anesthesia Versus General Anesthesia During Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia[J]. Surg Laparosc Endosc Percutan Tech, 2020, 30(4): 371-380.
[16]	吴向群, 王昕, 张庆. 超声引导下腰方肌阻滞联合丙泊酚麻醉在结直肠癌根治术中的应用效果分析[J]. 局解手术学杂志, 2022, 31(1): 51-55.
[17]	公艳芳, 李光, 李希明. 超声引导下神经阻滞麻醉在高龄无张力腹股沟疝修补术中的应用[J]. 中国现代普通外科进展, 2021, 24(3): 215-216, 219.
[18]	周达磊, 顾仕贤, 毛菇, 等. 联合神经阻滞应用于老年患者腹股沟疝修补术的镇痛效果[J]. 临床与病理杂志, 2021, 41(6): 1337-1344.
[19]	黄志, 夏维, 柯晋源, 等. 超声引导下髂腹股沟/髂腹下神经阻滞联合生殖股神经生殖支阻滞在老年腹股沟疝修补术中的应用效果[J]. 临床麻醉学杂志, 2020, 36(2): 135-139.
[20]	Luo Z, Tu H, Zhang X, et al. Efficacy and Safety of HSK3486 for Anesthesia/Sedation in Patients Undergoing Fiberoptic Bronchoscopy: A Multicenter, Double-Blind, Propofol-Controlled, Randomized, Phase 3 Study[J]. CNS Drugs, 2022, 36(3): 301-313.
[21]	翟春丽, 唐小娜, 王丙礼. 超声引导下罗哌卡因腹横肌平面阻滞对胃癌患者术后疼痛及认知功能的影响[J]. 海南医学, 2020, 31(12): 1504-1506.

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	美国麻醉医师协会分级[例(%)]		高血压[例(%)]	糖尿病[例(%)]
组别	例数	男性	女性	年龄(岁,±s)	体重指数(kg/m²,±s)	Ⅰ级	Ⅱ级	高血压[例(%)]	糖尿病[例(%)]
观察组	42	37(88.10)	5(11.9)	68.74±2.45	23.52±2.85	25(59.52)	17(40.48)	11(26.19)	6(14.29)
对照组	42	39(92.86)	3( 7.14)	68.85±2.37	23.57±2.89	23(54.76)	19(45.24)	9(21.43)	8(19.05)
t/χ²		0.553		0.209	0.08	0.194		0.263	0.343
P		0.457		0.835	0.937	0.659		0.608	0.558

组别	例数	性别[例(%)]		年龄(岁,±s)	体重指数(kg/m²,±s)	美国麻醉医师协会分级[例(%)]		高血压[例(%)]	糖尿病[例(%)]
组别	例数	男性	女性	年龄(岁,±s)	体重指数(kg/m²,±s)	Ⅰ级	Ⅱ级	高血压[例(%)]	糖尿病[例(%)]
观察组	42	37(88.10)	5(11.9)	68.74±2.45	23.52±2.85	25(59.52)	17(40.48)	11(26.19)	6(14.29)
对照组	42	39(92.86)	3( 7.14)	68.85±2.37	23.57±2.89	23(54.76)	19(45.24)	9(21.43)	8(19.05)
t/χ²		0.553		0.209	0.08	0.194		0.263	0.343
P		0.457		0.835	0.937	0.659		0.608	0.558

组别	例数	苏醒时	术后2 h	术后6 h	术后12 h	术后24 h
观察组	42	0.61±0.10	1.21±0.16	1.74±0.31	1.96±0.41	1.25±0.23
对照组	42	0.85±0.14	1.42±0.20	1.99±0.37	2.62±0.74	1.58±0.34
t		9.040	5.314	3.357	5.056	5.210
P		<0.001	<0.001	0.001	<0.001	<0.001

组别	例数	苏醒时	术后2 h	术后6 h	术后12 h	术后24 h
观察组	42	0.61±0.10	1.21±0.16	1.74±0.31	1.96±0.41	1.25±0.23
对照组	42	0.85±0.14	1.42±0.20	1.99±0.37	2.62±0.74	1.58±0.34
t		9.040	5.314	3.357	5.056	5.210
P		<0.001	<0.001	0.001	<0.001	<0.001

组别	例数	去甲肾上腺素(pg/ml)				皮质醇(ng/ml)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3
观察组	42	119.74±25.36	225.85±27.96	266.45±32.45	223.05±28.69	143.65±14.85	224.65±18.96	263.44±21.74	174.65±16.96
对照组	42	120.45±25.41	241.45±30.41	285.77±36.78	245.60±31.25	143.77±14.76	268.74±20.45	302.45±24.74	198.74±19.41
t值		0.128	2.447	2.553	3.445	0.037	10.246	7.676	6.057
P值		0.898	0.017	0.013	0.001	0.97	<0.001	<0.001	<0.001

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