超声引导髂腹股沟/髂腹下神经阻滞在斜疝手术的应用

Clinical Application of Ultrasound-guided Ilioinguinal/Iliohypogastric Nerve Block in Anesthesia of Inguinal Incision Surgery

目的观察超声引导行髂腹股沟/髂腹下神经阻滞在斜疝手术麻醉中的临床应用。方法择期行斜疝手术患者60例,年龄58-70岁,ASAI～II级。随机分为两组(n=30)。组I采用超声引导法,组Ⅱ采用体表标志法实施骼腹股沟/髂腹下神经联合阻滞。采用盲法即未告知术者麻醉采用何种方法,由同一位手术医生完成手术。两组术中均泵注瑞芬太尼辅助镇痛,必要时予局麻药浸润。观察并记录:麻醉时间;瑞芬太尼及利多卡因用量;术后24小时镇痛效果;及局部麻醉部位有无血肿等并发症。结果采用超声引导法术中瑞芬太尼用量,需加用利多卡因的次数和总量较体表标志法少(P﹤0.01);同时表现出良好的术后镇痛效果,术后24小时曲马多用量组I较组Ⅱ少(P﹤0.05)。结论超声引导下行髂腹股沟神经/髂腹下神经阻滞应用于老年患者斜疝手术时,麻醉效果确切、安全、可靠,并且能提供良好的术后镇痛效果。

Objective To investigate Ultrasound-guided ilioinguinal/iliohypogastric nerve block in anesthesia of hernia repair;and evaluate the effect on perioperative and postoperative analgesia.Methods Sixty patients undergoing inguinal hernia repair were randomly divided into two groups（n=24）.The patient received an ilioinguinal/iliohypogastric block performed either（groupI）under ultrasound guidance or（groupII） by the landmark-based techniques using 0.5% ropivacaine.Blind method was adopted for didn＇t tell operator which ground had selected.Additional intra-and postoperative local anaesthetics and analgesic requirements were recorded.The side effects of local block such as hematoma were observed.Result The anesthesia effect during operation showed better in ultrasound guidance group than in control group（p〈0.01）.The total dosage of remifentanil and lidocaine used in operation in ultrasound guidance group was less than that in control group（p〈0.05）.Furthermore,the effect on analgesia in ultrasound guidance group was better than that in control group at 24h after operation.Conclusion The ilioinguinal/iliohypogastric nerve block under ultrasound guidance exerts reliable anesthesia efficacy and satisfactory postoperative analgesia with few pefioperative complications in elder undergoing inguinal hernia