Abstract:

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.

Key words: Hernia, inguinal, Ultrasound-guided ilioinguinal and iliohypogastric nerve block, Nalbuphine, Pain, Enhanced recovery after surgery