超声引导下腹横肌平面阻滞对老年腹股沟疝修补术患者术后疼痛的影响

Effects of ultrasound guided transversus abdominis plane block on postoperative analgesia in elderly patients undergoing inguinal hernia repair

目的探讨超声引导下腹横肌平面阻滞对老年腹股沟疝修补术患者术后疼痛的影响。方法选择2016年5-12月,南京大学医学院附属鼓楼医院择期行单侧腹股沟疝无张力修补手术老年患者80例,年龄≥60岁,男性,ASA分级Ⅰ~Ⅲ级,采用随机数字表法分为2组:对照组(C组)及实验组(TAP组),每组40例。C组行常规全身麻醉,TAP组全麻后行超声引导下腹横肌平面阻滞,患侧注射0.375%罗哌卡因20 ml,所有患者操作均由同一麻醉医师完成;采用视觉模拟疼痛(VAS)评分评估术后2、4、6、12、24、48 h疼痛程度,并记录腹横肌平面阻滞穿刺相关误入血管、腹腔、刺破脏器、穿刺部位感染、局麻药中毒等不良事件的发生情况。结果 2组患者的年龄、体重指数、ASA分级、手术时间等均无统计学差异(P>0.05);TAP组患者术后2、4、6、12、24 h VAS评分均较C组下降(P<0.05),术后48 h VAS评分2组比较,差异无统计学意义(P>0.05);TAP组未见腹横肌平面阻滞相关不良事件的发生。结论超声引导下腹横肌平面阻滞可为老年腹股沟疝修补术患者提供良好的术后镇痛,且安全性良好,值得临床推广。

Objective To evaluate the efficacy of ultrasound guided transversus abdominis plane block for？ postoperative analgesia in elderly patients undergoing inguinal hernia repair. Methods From May 2016 to December 2016, eighty male patients （aged ≥60 years, American Society of Anesthesiologists physical status I , II or III ） undergoing elective tension-free repair of inguinal hernia, were equally randomized into either control group （group C） or TAP block group （group TAP）. Group C underwent routine general anesthesia while group TAP received ultrasound-guided transversus abdomins plane block, with ipsilateral injection of 0. 375% ropivacaine 20 ml. The visual analogue score （VAS） was used to evaluate the pain level of 2, 4, 6, 12, 24 and 48 hours after operation and the occurrence of TAP block related adverse events were recorded. Results There were no significant differences between the two groups in age, body mass index, ASA grade, Duration of surgery （P 〉 0.05）. The VAS score were lower at 2, 4, 6, 12, 24 hours after operation in group TAP than that in group C （ P 〈 0.05 ）, There was no significant difference in VAS score at 48 hours after operation between the two groups （P 〉 0.05 ）. No TAP block related adverse events were observed in group TAP. Conclusion Ultrasound guided transversus abdominis plane block, provides a good efficacy for postoperative analgesia with good safety in elderly patients undergoing inguinal hernia repair.