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| 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 |
| Effect of ultrasound-guided genital branch of genitofemoral nerve block combined with ilioinguinal／iliohypogastric nerve block for anesthesia of inguinal hernia repair in elderly patients |
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| DOI：10.12089/jca.2020.02.007 |
| 中文关键词: 老年患者 腹股沟疝修补术 髂腹股沟神经阻滞 髂腹下神经阻滞 生殖股神经生殖支阻滞 |
| 英文关键词: Elderly patients Inguinal hernia repair Ilioinguinal nerve block Iliohypogastric nerve block Genital branch of genitofemoral nerve block |
| 基金项目:湖北省卫生健康科研基金资助(WJ2019F015) |
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| 中文摘要: |
目的 观察超声引导下髂腹股沟／髂腹下神经(ilioinguinal／iliohypogastric nerve,IIIHN)阻滞联合生殖股神经生殖支阻滞应用于老年腹股沟疝修补术的效果。
方法 择期行单侧无张力疝修补术的腹股沟斜疝老年患者53例,男52例,女1例,年龄65～96岁,体重55～82 kg,ASA Ⅰ—Ⅲ级,采用随机数字表法将患者随机分为两组:IIIHN阻滞联合生殖股神经生殖支阻滞组(G组,n=27例)和IIIHN阻滞组(I组,n=26例)。两组均行超声引导下IIIHN阻滞,注入0.5％罗哌卡因0.25 ml／kg。G组联合生殖股神经生殖支阻滞,注入0.5％罗哌卡因10 ml。阻滞完成30 min后测试皮区感觉神经阻滞效果,记录切皮时、牵拉精索／圆韧带时、行疝囊高位结扎时的VAS疼痛评分,记录术中舒芬太尼、布托啡诺使用情况和术后曲马多补救镇痛情况,记录区域阻滞效果评级以及穿刺部位血肿、腹内脏器损伤、股神经被阻滞表现、阻滞后感觉异常、局麻药中毒、术后恶心呕吐、尿潴留等并发症的发生情况。
结果 两组皮区感觉神经阻滞效果差异无统计学意义。切皮时和行疝囊高位结扎时两组VAS疼痛评分差异无统计学意义。牵拉精索／圆韧带时G组VAS疼痛评分明显低于I组 ［(2.0±1.0) 分vs (4.7±1.4) 分,P＜0.05］。G组术中舒芬太尼、布托啡诺使用率明显低于I组(P＜0.05)。两组术后曲马多补救镇痛率差异无统计学意义。G组区域阻滞效果评优者比例明显高于I组［25例(92％)vs 8例(31％),P＜0.05］,区域阻滞效果评良者比例明显低于I组［2例(7％)vs 18例(69％),P＜0.05］。两组各有1例发生术后尿潴留,两组均无其他并发症发生。
结论 髂腹股沟／髂腹下神经阻滞联合生殖股神经生殖支阻滞应用于老年腹股沟斜疝修补术,效果优于髂腹股沟／髂腹下神经阻滞。 |
| 英文摘要: |
Ojective To evaluate the anesthesia effect of ultrasound-guided ilioinguinal／iliohypogastric nerve (IIIHN) block combined with genital branch of genitofemoral nerve (GFN) block on elder patients in inguinal hernia repair.
Methods Fifty-three elderly patients with indirect hernia scheduled for unilateral tensing-free herniorrhaphy, 52 males and 1 females, aged 65-96 years, weighing 55-82 kg, falling into ASA physical status Ⅰ-Ⅲ, were randomized to receive either ultrasound-guided IIIHN plus genital branch of GFN block (group G, n = 27) or ultrasound-guided IIIHN block alone (group I, n = 26). Each patient received 0.5％ ropivacaine 0.25 ml／kg for the ultrasound-guided IIIHN block and patients in group G received an additional GFN block with 0.5％ ropivacaine 10 ml. Sensory block of the skin area was assessed 30 min later. Intraoperative VAS scores were recorded at the times of skin incision, stretching spermatic cord／round ligament and high ligation of the hernia sac. The requirement of sufentanil, butorphanol tartrate and postoperative tramadol remedy and analgesia were recorded. The regional block effect rating, puncture site hematoma, abdominal organ damage, femoral nerve block, and block complications such as delayed paresthesia, local anesthetic poisoning, postoperative nausea and vomiting and urinary retention were recorded.
Results Both groups showed similar effects on sensory block 30 min after anesthesia. There was also no statistical significance in comparing the VAS score when making the skin incision or ligating hernia sac. When stretching spermatic cord／round ligament, the patients in group G had significantly lower VAS scores than those in group I ［(2.0 ± 1.0) vs (4.7 ± 1.4), P ＜ 0.05］. Patients in group G used significantly smaller amount of adjuvant sedatives and analgesics for adequate anaesthesia, including sufentanil and butorphanol (P ＜ 0.05). There was no significant difference in the rate of postoperative tramadol analgesia between the two groups. The proportion of those who rated good regional blockade effect in group G was significantly higher than that in group I ［25 cases (92％) vs 8 cases (31％), P ＜ 0.05］. The proportion of those who rated acceptable regional blockade effect in group G was significantly lower than that in group I ［2 cases (7％) vs 18 cases (69％), P ＜ 0.05］. One patient in each group had postoperative urinary retention, and no other complications occurred in either group.
Conclusion The combination of GFN block and IIIHN block showed better anesthesia effect in herniorrhaphy for elder patients, as compared to IIIHN block alone. |
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