To explore the effects of posterior quadratus lumborum block (QLB) combined with general anesthesia on perioperative stress and intraoperative remifentanil dosage in patients with indirect inguinal hernia (IIH) undergoing trans-abdominal preperitoneal hernia repair (TAPP) .

Ninety-four patients with IIH admitted to Linquan County People's Hospital from February 2020 to October 2022 were selected as subjects. All patients were treated with TAPP surgery. According to the different anesthesia methods, the patients were divided into general anesthesia group and combined anesthesia group, with 47 cases in each group. The general anesthesia group received general anesthesia, and the combined anesthesia group received posterior QLB 30 min before general anesthesia. Hemodynamic indicators [mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO₂)] before the implementation of anesthesia (T0), immediately after tracheal intubation (T1), before the beginning of surgery (T2), 10 min after the beginning of surgery (T3), immediately after the end of surgery (T4) and at the time of extubation (T5), anesthesia recovery quality, intraoperative remifentanil dosage and postoperative remedial analgesia, perioperative pain [Visual Analogue Scale (VAS)], stress response [prolactin (PRL), blood glucose (Glu), growth hormone (GH)] and occurrence of adverse reactions were compared between the two groups.

There were no statistical differences in HR and MAP from the aspects of between-group effect, time-point and interaction of between-group× time-point (P>0.05). The postoperative spontaneous breathing recovery time, extubation time, eye opening time and orientation recovery time in combined anesthesia group were significantly shorter than those in general anesthesia group (P<0.05). The intraoperative remifentanil dosage, frequency of effective compressions of analgesic pump and sufentanil dosage within 48 h after surgery were significantly lower in combined anesthesia group than those in general anesthesia group (P<0.05). There was no statistical difference in the number of remedial analgesia between the two groups within 48 h after surgery (P>0.05). There was a statistical difference in VAS score from the aspects of between-group effect, time-point and interaction of between-group×time-point (P<0.05), and there was a statistically significant difference in VAS score within and between the groups at different time points after surgery (P<0.05). There were statistical differences in the levels of PRL, Glu and GH between groups, at different time points and between groups×time points (P<0.05). The levels of PRL, Glu and GH in the two groups 20 min after skin incision and 2 h after surgery were significantly higher than those 10 min before anesthesia (P<0.05), and serum levels of PRL, Glu and GH in combined anesthesia group were significantly lower than those in general anesthesia group 20 min after skin incision and 2 h after surgery (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (8.51% vs 12.77%, P>0.05).

Posterior QLB combined with general anesthesia for anesthesia of IIH patients undergoing TAPP is helpful to reduce intraoperative remifentanil dosage, enhance postoperative analgesia effect, and relieve perioperative stress response.